The Epilepsy rotation combines inpatient and outpatient EEG reading, epilepsy monitoring unit and outpatient clinic experiences in a 1-2 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 physician.
Prior to the start of the rotation, check in with the epilepsy attending 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, as the residents also need to coordinate which EEG’s to read each day.
The fellow will spend most mornings rounding in the epilepsy monitoring unit (EMU) and reading those patients’ EEGs, as well as those of the patients undergoing continuous monitoring elsewhere in the hospital (such as the ICUs), except Monday Morning spent in the VA epilepsy clinic.
In the afternoons, the fellow will read routine EEGs, and spend one half day each week in an epilepsy clinic.
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ACGME Competency Goals
The fellow will be able to diagnosis and provide appropriate treatment for various epilepsy syndromes as well as the treatment of status epilepticus. Fellow will be able to care for patients in the adult epilepsy monitoring unit and determine withdrawal of medications, duration of monitoring, and need for ancillary testing.
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 pediatrics and adults. The fellow will be able to accurate localize seizure onset electrographically and via seizure semiology. The fellow will be to develop a treatment plan (surgical, dietary, neurostimulation) based on findings in the epilepsy monitoring unit including development of an epilepsy surgical plan. Additionally, the fellow will know the indication and utility of non-EEG testing associated with epilepsy diagnosis and treatment including neuropsychological testing, PET, MRI, SPECT, MEG, fMRI, and Wada tests.
Interpersonal and Communication Skills
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 in regards to EEG findings and interpretation of these findings within the clinical context of patient.
Practice-Based Learning and Improvement
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, EMU and epilepsy conference notes.
The fellow recognizes that he/she is part of a treatment team and participates within the treatment group effectively. The treatment groups including neurology/neurocritical care, neuroradiology, neurosurgery, and EEG technologists.
Objectives and Evaluation Matrix
As with all of the individual rotations described in this section, the specific objectives of the continuity clinic are reflected in the entrustable professional activities and individual milestones. These form the basis for the fellow’s evaluation, which is completed by his or her clinic attending twice each year. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).
Upon completion of the curriculum, fellows will . . .
New EPA Description
|Obtain an epilepsy history and classify the spells, seizures, and epilepsy syndrome
|PC1, PC2, MK1-3
|Evaluate patients with intractable epilepsy and develop a treatment plan
|PC3-4, MK2, SP3, SP4
|Counsel patients regarding their study results and medications
|PC3, MK2, PC7, IC1, IC3,
|Interpret intracranial EEG findings and perform extra-operative mapping
|Counsel and manage epilepsy patients regarding pregnancy, driving, and safety issues
|PC3, MK1, IC1, IC3,
|Read and interpret cEEG studies and guide the treating team regarding the appropriate course of treatment including in emergencies
|PC3, PC4, PC5, PC7, PL1, SP3, IC4, IC5
|Understand the pharmacology of antiepileptic drugs
|Effective case presentation in case conferences to devise an individual treatment plan
|SP3, SP4,PL1, PR2, IC4, IC5
|Appropriately utilization of non-invasive tests such as PET, SPECT and MEG among patients with intractable epilepsy
|Understand and manage electrical stimulation among patients with epilepsy
|PC3, PC4, MK1
The estimated number of work hours per week is 45.
Chiappa, K. H. (1997). Evoked potentials in clinical medicine. Philadelphia; New York: Lippincott-Raven.
Fisch, B. J., & Spehlmann, R. (2009). Fisch and Spehlmann’s EEG primer : basic principles of digital and analog EEG. Amsterdam [etc.]: Elsevier.
Wyllie, E., Gidal, B. E., Goodkin, H. P., Loddenkemper, T., & Sirven, J. I. (2015). Wyllie’s treatment of epilepsy : principles and practice.
In addition, there are teaching files with EEG training materials maintained in the EEG laboratory
Latest revision: 10/28/2022, Aaron Struck, MD