Epilepsy Monitoring Unit (EMU)

Introduction

The Epilepsy rotation combines 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 studies and 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 which when available will take precedence over other duties. Fellows provide preliminary readings of most EEG studies and review all studies with the attending physicians. Fellow will be responsible for preparing presentation for the Friday epilepsy conference.

Goals

The fellow will be able to recognize and provide appropriate treatment for various epilepsy syndromes as well as 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 and sleep states.
The fellow will be diligent and thorough in hand-offs. The fellow will maintain a professional demeanor during all interpersonal communications.
The fellow will effectively communicate with treating providers about EEG findings and interpretation of these findings within a patient’s clinical context.
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 will be professional in verbal communications and in timely reporting of EEG studies and notes.
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

EMU Rotation Objectives Upon completion of the curriculum, fellows will . . .
EPA #	EPA Description	Milestones
1	Interpret routine outpatient and inpatient EEG in adults	PC3, MK3
2	Interpret continuous video inpatient EEGs, including providing assistance in the management of inpatients with seizure disorders including status epilepticus	PC1, PC2, PC3, MK1, MK3, SP3
3	Understand seizure semiology and electrographic localization of seizures	PC1, PC2, PC3, MK1, MK3
4	Describe placement and interpretation of intracranial EEG monitoring in the work-up for epilepsy surgery	PC1, PC2, PC3, MK1, MK3
5	Develop a treatment plan for patient admitted to the epilepsy monitoring unit	PC1, PC2, PC3, MK1, MK4
6	Demonstrate professionalism and communicates effectively with Neurophysiology Technologists, nurses, ordering providers and other team members	SP3, PR1, PR2, PR3, IC4, IC5
7	Participate in family meetings regarding goals of care and help negotiate conflicts among family members and the treatment team	IC1, IC2, IC3

Schedule

EMU (Epilepsy Monitoring Unit)	Name of shift/clinic/conf.
Monday – AM	VA Epilepsy Clinic
Monday – PM	EMU Admissions, Inpatients, Outpatients, VA EEG

Tuesday – AM	EMU Admissions, Inpatients, Outpatients, VA EEG
Tuesday – PM	Clinic

Wednesday – AM	EMU Admissions, Inpatients, Outpatients, VA EEG
Wednesday – PM	UW Epilepsy Continuity Clinic

Thursday – AM	EMU Admissions, Inpatients, Outpatients, VA EEG
Thursday – PM	Clinic

Friday – AM	EMU Admissions, Inpatients, Outpatients, VA EEG
Friday – PM	EMU Admissions, Inpatients, Outpatients, VA EEG

Fellow will also be aiding with reports/rounding on EMU patients in the VA and at the UW.

Conferences

Attend per conference requirements. Participate in weekly Epilepsy book club.

Work Hours

Standard work hours

Latest Revision: 04/20/2023, Smitha Holla, MD