EEG – Pediatric

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Pediatric Epilepsy Fellow Rotation Expectations

  1. 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.  The purpose of this activity is to better understand the process of epilepsy surgery workup in children; the fellow will not do more than 3 history and physicals or consults weekly.
  2. 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.
  3. Attend any pediatric epilepsy surgery cases, functional mapping, etc.  These experiences will take precedence over reading routine EEGs or attending afternoon clinic.
  4. 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.
  5. 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.

ACGME Competency Goals

Patient Care

Goals: 
The fellow will be able to recognize and provide appropriate treatment for various pediatric epilepsy syndromes as well as the treatment of status epilepticus.

Medical knowledge

Goals:
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.

Interpersonal and Communication Skills

Goals:
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

Goals:
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.

Professionalism

Goals:
The fellow will be professional in verbal communications and in timely reporting of EEG studies and notes.

Systems-Based Practice

Goals:
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).

Rotation Objectives

Upon completion of the curriculum, fellows will…

EPA#New EPA DescriptionMilestones
1Obtain a history and classify the events and the epilepsy syndrome for pediatric and neonatesPC1, PC2,PC6, MK1, MK2, MK3, PL1
2Develop pediatric patients’ treatment plans in the outpatient settingPC3, PL1, MK2, SP3, IC1
3Counsel patients, both inpatient and outpatient, with spells/epilepsy regarding study resultsPC3, PC7, MK3, IC1, IC3
4Evaluate patients in the EMU and develop management plansPC1, PC2, SP3, SP4, IC5
5Interpret a pediatric and neonatal EEG, recognize artifacts, normal variants, and ictal patternsPC7, MK1
6Interpret EMU studies and develop individualized treatment plansPC3, PC7, MK1,MK2, MK3, SP3, SP4, IC5
7Interpret emergent EEG and cEEG studies, and recommend treatment plans for the treating teamPC5, PC7, MK1,MK2, MK3, SP3, SP4, IC4, IC5

Work Hours

The estimated number of work hours per week is 45. There is no call responsibility.

Suggested References

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

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