Faculty Supervisors:
- Dr. Rachael Benson and rotating faculty
The Epilepsy rotation is a two -week educational experience for PGY-1 residents. During this rotation, residents become a member of the Epilepsy Division, and participate in all of its clinical and educational activities.
- Structured teaching in EEG/Electrophysiology
Familiarity with basic EEG is required of residents by the Residency Review Committee [RRC] as well as the American Board of Psychiatry and Neurology [ABPN]. Each morning, one overnight EEG should be read and reviewed with the attending at the beginning of EMU rounds. Each afternoon one routine EEG will be reviewed with the routine EEG attending. The resident should read a basic EEG text or syllabus in the first day(s) of the rotation as well. - In-patient epilepsy service/EMU experience
The core objectives can be realized by being an active participant of the Epilepsy Monitoring Unit [EMU] team. The majority of the patients are elective admissions which provides an ambulatory experience, but with the advantage of rapid feedback in terms of clinical and surgical epilepsy and EEG.
Residents will admit patients to the EMU each day of the week A detailed review of the case based on the resident’s own history, exam and review of the records (including outpatient charts as appropriate) will be presented to the attending during rounds. Seizure semiology, seizure frequency, risk factors for epilepsy, medications attempted, differential diagnosis and an impression with lateralization or localization of the epileptogenic zone are pertinent details to present. Residents will assume full clinical responsibility for their patients, with supervision by clinical epilepsy fellows and the attending.
Location:
Epilepsy Division, Neurological Institute, 7th floor; Milstein Hospital Building, Epilepsy Monitoring Unit
Evaluation:
Performance written evaluations are provided by the EMU attending who receive the resident’s presentations using the electronic Medhub system. Verbal feedback is provided at the end of the rotation by supervising faculty.
Goals & Objectives:
Medical Knowledge
Understand the cellular basis & neuronal mechanisms that produce the EEG and the correlation with neuronal membrane properties, including ion channels and resting and action potentials.
Understand the basic techniques of EEG including lead placement, activation techniques, and methods of modifying the signal obtained from the EEG.
- To recognize awake, drowsy and sleep states by EEG in adults, artifact, as well as describe background activity, localize focal abnormalities, and identify epileptiform discharges
- To recognize and define electrographic seizures, and be able to interpret prolonged bedside and outpatient recordings
- To evaluate the utility of EEG in assessing coma and altered mental status, including brain death
- Identify the indications for prolonged or special EEGs for assessment of coma, status epilepticus, encephalopathy, and brain death
To learn the classification of seizures and of seizure syndromes, as well as characteristics of seizures with onset from different cortical areas.
- To learn the evaluate and management of patients with suspected non-epileptic events
- To attain a basic knowledge of the various surgical procedures available, and the appropriateness to each epilepsy syndrome
Patient Care
Care for patients with the goal of ‘no seizures, no side-effects’ by knowing the side-effect profiles of each anti-epileptic drug and their appropriateness for the various epilepsy syndromes.
- Understand the pharmacokinetics and pharmacodynamics of AEDs, common side effects and medication interactions.
- To gain knowledge of treatment options for refractory epilepsy, including surgery, vagus nerve stimulator placement, ketogenic and low glycemic diets, experimental drugs.
Interpersonal and Communication Skills
Be able to counsel patients and their families, across a broad range of socioeconomic and cultural backgrounds, about seizures (prognosis, risks and therapeutic options)
Be able to effectively communicate the ramifications of different EEG readings to non-neurology health personnel, including attending and resident physicians on other services
Learn how to interpret and dictate EEG reports that effectively communicate the findings
Professionalism
Show compassion and respect for patients and their families, peers and all those involved with patient care
Show responsiveness to patient needs that supersedes self-interest
Demonstrate respect for patient privacy and autonomy
Demonstrate respect and sensitivity for different cultural beliefs and for varied socioeconomic levels, particularly when discussing the goals of seizure management
Systems-Based Practice
Know the economic burdens of choosing different AEDs based on various health care plans
Know how to utilize other resources (psychiatry, psychology, genetics, physical and occupational therapy, nutrition and rehabilitation) to help patients live with epilepsy and its frequently associated co-morbidities
Practice-Based Learning and Improvement
Be able to discuss how recent literature supports efficacy of recently introduced AEDs for specific seizure syndromes
- Follow epidemiologic studies for updated side effects of newer AEDs---particularly in regard to effects on the disabled, multiply-handicapped, infants, the elderly and pregnant women
Assess efficacy and side effects of various treatments on established patients
Participate in the education of others, including patients and other health professionals
Updated 7/21/25