Introduction
The Pediatric Epilepsy EMU rotations combine inpatient and outpatient EEG reading, epilepsy monitoring unit and outpatient clinic experiences in a 1-week block. This is a foundational experience with close daily interactions with the attending and other members of the team including inpatient hospital staff and EEG technicians. Daily EEG readings include routine and continuous monitoring studies, as well as analysis of EMU patient data which may include scalp or intracranial EEGs, integration with imaging data such as fMRI, PET or SPECT, and bedside mapping. Fellows provide preliminary readings of most EEG studies and review all studies with the attending physicians.
In the Pediatric Epilepsy EMU rotation, reading of EMU and outpatient studies are prioritized as described below.
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Rotation Expectations
- When instructed by the EMU attending, perform history and physical for phase 1 epilepsy surgery patients being admitted to the EMU, or an initial consult for phase 2 or postop epilepsy surgery patients. This activity’s purpose is to better understand epilepsy surgery workup in children; the fellow will not do more than 3 history and physicals or consult weekly.
- Read video EEGs – arrive by 8AM, begin by reading continuous EEG studies. Generate a report for each study, discuss with the attending how they prefer to manage addendums to ongoing studies. The attending may read studies concurrently.
- Attend any pediatric epilepsy surgery cases, functional mapping, etc. These experiences will take precedence over reading routine EEGs or attending afternoon clinic.
- Read bedside and routine EEG studies and generate reports for these studies. At the start of the day, contact the CEOD (clinical epileptologist of the day, that is, the outpatient pediatric EEG attending) to pick and time and place to review studies in the afternoon.
- One afternoon weekly, the fellow will attend complex epilepsy clinic with one of the pediatric epileptologists (you will be provided a schedule before the start of a two-week block). In clinic the fellow will independently see new patients, formulate an assessment and management plan, and staff with the attending epileptologist. It is up to the attending whether the fellow will independently see return patients. The fellow will not be responsible for reading routine EEGs on the clinic day.
Goals
- The fellow will learn to recognize and provide appropriate treatment for various pediatric epilepsy syndromes and the treatment of status epilepticus.
- The fellow will understand the basic principles of EEG from electrode placement, amplifiers, and digital signal processing. The fellow will be able to determine common EEG artifact, benign variants, normal background patterns in awake, drowsy, sleep in neonatal to pediatrics.
- The fellow will be diligent and thorough in hand-offs. He/she will maintain a professional demeanor during all interpersonal communications. His/her communications with treating providers will be effective regarding EEG findings and interpretation of these findings within the clinical context of patient. Reports will be timely.
- The fellow will be involved in improving the quality of the care of epilepsy patients and others with critical neurological illness through QI projects, scholarly activities, and/or participation in weekly multi-disciplinary EEG/epilepsy conferences which include peer-review and practice improvement.
- The fellow recognizes that he/she is part of a treatment team and participates within the treatment group effectively. The treatment groups include neurology/neurocritical care, neuroradiology, neurosurgery, and EEG technologists.
Objectives and Evaluation Matrix
Rotation ObjectivesUpon completion of the curriculum, fellows will… | ||
# | Description | Milestones |
1 | Obtain a history and classify events and epilepsy syndromes for pediatric and neonates | PC1, PC2,PC6, MK1, MK2, MK3, PL1 |
2 | Develop pediatric patients’ treatment plans in the inpatient and outpatient settings | PC3, PL1, MK2, SP3, IC1 |
3 | Counsel patients, both inpatient and outpatient, with seizures and nonepileptic events regarding study results | PC3, PC7, MK3, IC1, IC3 |
4 | Evaluate patients in the EMU and develop management plans | PC1, PC2, SP3, SP4, IC5 |
5 | Interpret pediatric and neonatal EEGs: recognize artifacts, normal variants, and epileptiform patterns | PC7, MK1 |
6 | Interpret EMU studies and develop individualized treatment plans | PC3, PC7, MK1,MK2, MK3, SP3, SP4, IC5 |
7 | Interpret emergent EEG and cEEG studies, and recommend treatment plans for the treating team | PC5, PC7, MK1,MK2, MK3, SP3, SP4, IC4, IC5 |
Additional Milestones |
PC9, SP4, PR1, PR2, PR3, IC2 |
Schedule
8am – 4pm at American Family Children’s Hospital (AFCH) with one afternoon per week where they will attend clinic at UWHC pediatrics
Conferences
Attend pediatrics epilepsy conference and all other required conferences.
Work Hours
Standard work hours
Latest Revision: 06/10/2024, Smitha Holla, MD