DEPARTMENT OF NEUROLOGY
University of Wisconsin School of Medicine and Public Health
Header Child Neurology

Child Neurology Residency

Epilepsy rotation

Introduction

The UW Department of Neurology strives to provide the best possible care for patients with epileptic disorders at the UW Hospitals and Clinics. Residents rotate on this service during the PGY3 year.  This will be adjusted to reflect the individual resident’s existing continuity clinic schedule. Additional pediatric epilepsy rotations occur during the PGY 4 and 5 years. The rotation encompasses both inpatient and outpatient care.

Schedule

MondayTuesdayWednesdayThursdayFriday
AMEMU admissions prep/EEG ReadingEMUEMUEMUEpilepsy Conference if possible 12-1

EMU

PMEMU admissions EEG readingEEG readingEEG readingCCEEG reading
  • Prior to the start of the rotation, check in with the EMU attending or adult neurology resident by sending them an email on the Thursday or Friday beforehand to plan out the what and where on the first day. This is especially helpful, since there is not always a fellow on service.
  • The resident will spend most mornings rounding in the epilepsy monitoring unit (EMU) and reading those patients’ EEGs.
  • In the afternoons, the resident will spend four half days reading routine EEGs, in addition to their regularly-scheduled afternoon continuity clinic.  Typical volume for a resident is 2 to 4 outpatient EEGs per day.
  • Learning may be supplemented with inpatient continuous monitoring study review.

Work Hours

The estimated number of work hours per week is 50. Monday evenings consist of a 4-8 PM ‘short call’ as per Rotations and Call Schedule section.

Patient Care

Goals

  1. Develop the skills necessary to evaluate, treat, and counsel patients of all ages and families with epileptic disorders.
  2. Gather essential and accurate information necessary to provide comprehensive care to adult and pediatric patients with epileptic disorders.
  3. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
  4. Recognize the ethical, personal and social implications of the diagnosis of epilepsy as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities.
  5. Provide care to patients of varying ages with epilepsy and develop skills necessary to provide longitudinal care throughout their lifespan.

Objectives

Residents will:

  1. Obtain accurate and sufficient histories to characterize seizures and to define risk factors for developing epilepsy.
  2. Review AAN practice guidelines and learn to incorporate them into the evaluation and treatment of patients with epilepsy.
  3. Demonstrate communication skills to educate patients and families regarding epilepsy diagnosis and treatment.
  4. Work with health care professionals (i.e. nursing staff, neurophysiology technologists, ancillary staff) to provide patient-focused care.
  5. Attend Epilepsy clinics, admit and manage monitoring patients.
  6. Review electrophysiological studies and apply findings to care for patients with epilepsy.
  7. Formulate patient management plans regarding appropriate diagnostic and therapeutic interventions

Medical Knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in neurology.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of epilepsy in all ages.
  3. Develop an adequate knowledge base in epileptology.
  4. Learn how the health care system functions, especially as relevant to the patient with epilepsy.

Objectives

Residents will:

  1. Explain the recognition and treatment of status epilepticus, a medical emergency.
  2. Take a personal initiative in self-education (including perusing recent literature). This includes review of standard texts of EEG interpretation and epilepsy disorders as includes review of teaching files of normal and abnormal EEGs.
  3. Describe the importance of neuroimaging in the evaluation of patients with epilepsy.
  4. Be able to classify seizure types and epileptic syndromes.
  5. Verbalize a rational approach to the management of epilepsy including choice of appropriate antiepileptics.
  6. List the pharmacokinetics of antiepileptics and mechanisms of action.
  7. Explain the utility of epilepsy monitoring and the evaluation of intractable epilepsy, especially the use of surgical treatment of epilepsy.
  8. Characterize the unique situation of epilepsy in women of child bearing age.
  9. Verbalize the appropriate restrictions including driving, for patients with epilepsy.
  10. Describe the principles of EEG generation and recording.
  11. Achieve an orderly approach to the interpretation of EEG studies.
  12. Identify normal and abnormal EEG patterns.
  13. Describe the developmental features of EEG from infancy to the elderly.
  14. Recognize abnormal EEG findings and correlate EEG findings with clinical epilepsy syndrome and seizure types in infancy, childhood and adulthood.
  15. Achieve skills in creating and dictating neurophysiology reports.
  16. Explain the principles of evoked potential generation including visual, brainstem-auditory, and somatosensory evoked potentials.
  17. Correlate video recordings of seizures with EEG tracing.
  18. Describe the principles of Wada testing.
  19. Dictate at least five EEG studies.

Practice-Based Learning and Improvement

Goals

  1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making
  2. Identify opportunities for improvement in the delivery of quality of patient care.

Objectives

Residents will:

  1. Appraise literature to better understand pediatric and adult epilepsy syndromes and their etiology and clinical presentation.
  2. Assess studies that evaluate treatment options for specific seizure types and epilepsy syndromes.
  3. Apply and use the International League Against Epilepsy (ILEA) website that aids in understanding epilepsy syndromes and seizure management.

Interpersonal and Communication Skills

Goals

  1. Become skillful listeners, and develop specific proficiency in communicating with patients with epilepsy of all ages.
  2. Learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner.
  3. Learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team.

Objectives

Residents will:

  1. Develop techniques to obtain accurate history from patients, and gain the patients’ confidence and trust.
  2. Create reports that accurately convey EEG findings and relate these findings to the clinical setting.
  3. Interact effectively with other members caring for patients including nursing and technical staff.
  4. Create clinic and hospital notes that are concise and accurate.

Professionalism

Goals

  1. Demonstrate continuing commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
  2. Learn ethical, regulatory, and legal aspects of care for pediatric and adult patients with epilepsy, including the difference between standard and investigational treatments.
  3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.
  4. Demonstrate responsiveness to patient needs that supersedes self-interest.
  5. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  6. Adhere to ethical principles by respecting confidentiality of medical information.

Objectives

Residents will:

  1. Show respect, compassion, integrity and ongoing professional development.
  2. Verbalize ethical principles with adherence to confidentiality, HIPAA principles, and appropriate informed consent.
  3. Determine psychosocial issues that complicate care, especially as it relates to the possibility of patient history of physical or sexual abuse and the diagnosis of nonepileptic seizures.
  4. Be punctual and appropriately attired.
  5. Keep patient logs up-to-date on MedHub.

Systems Based Practice

Goals

The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.

Objectives

Residents will:

  1. Identify the importance for proper diagnosis and treatment of epilepsy as to the effect of diagnosis on insurability and driving privileges.
  2. Assess efficiencies of the UW system regarding patients referred from other centers, and develop management plans that are effective and not redundant or wasteful of medical resources.
  3. Make decisions regarding the cost considerations of choosing appropriate antiepileptic drug therapy.
  4. Identify advocacy programs for patients with epilepsy.

Suggested References

Fisch, B. J., & Spehlmann, R. (2009). Fisch and Spehlmann’s EEG primer : basic principles of digital and analog EEG. Amsterdam [etc.]: Elsevier.

Husain, A., (2023) Current Practice of Clinical Electroencephalography, 5th Ed.

Wyllie, E., Gidal, B. E., Goodkin, H. P., Loddenkemper, T., & Sirven, J. I. (2015). Wyllie’s treatment of epilepsy : principles and practice.

Suggested free online resources/viewing:

EEG Talk on YouTube

Learningeeg.com 

https://pn.bmj.com/content/21/6/48  This is a pdf with embedded videos for an overview of focal epilepsy localization and seizure semiology

https://www.ncbi.nlm.nih.gov/books/NBK390354/ Electroencephalography (EEG): An Introductory Text and Atlas of Normal and Abnormal Findings in Adults, Children, and Infants

 

Last reviewed: 9/12/2024, Adam Wallace