Introduction
The Epilepsy rotation combines 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.
This is an accordion element with a series of buttons that open and close related content panels.
Goals
- The fellow will 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 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 will recognize that they are a 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
Epilepsy Rotation ObjectivesUpon 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
| Epilepsy | Name of shift/clinic/conf. |
| Monday – AM | VA Epilepsy Clinic |
| Monday – PM | EEG with EMU attending & new LTM with LTM attending |
| Tuesday – AM | LTM with LTM attending |
| Tuesday – PM | EEG with EMU attending & new LTM with LTM attending |
| Wednesday – AM | LTM with LTM attending |
| Wednesday – PM | UW Epilepsy Continuity Clinic |
| Thursday – AM | LTM with LTM attending |
| Thursday – PM | EEG with EMU attending & new LTM with LTM attending |
| Friday – AM | LTM with LTM attending |
| Friday – PM | EEG with EMU attending & new LTM with LTM attending |
Long-term monitoring (LTM) tasks with LTM attending include:
- Read overnight cEEG studies
- Read new bedside EEG studies
- Not required to round on EMU patients
Epilepsy monitoring unit (EMU) tasks with EMU attending include:
- Read out patient EEGs with EMU attending
- Help residents update EMU EEG reports
- Review clinical data on EMU patients in preparation for Friday Epilepsy conference
- Start reports on any new cEEG/bedside EEG studies
- Not responsible for afternoon updating of existing cEEG reports
Apart from Monday morning clinic, the remaining time is all 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
