Rotation Specific Objectives

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Electroencephalography (EEG)

Faculty Supervisors: Rotating attending.

The goal of the EEG rotation is to provide the trainees with the expertise in performing, evaluating, and interpreting electroencephalograms.

By the end of the academic year, Fellows should be able to:

  • Objective 1: Interpret EEG tracings of adults and children [MK]
  • Objective 2: Utilize knowledge of electrical safety to ensure safe recording conditions, including in patients with indwelling catheters and electrodes [MK]
  • Objective 3: Recognize EEG patterns corresponding to diffuse encephalopathies, focal brain lesions and dementias, ictal and interictal EEG patterns related to the diagnosis of epilepsy, and to the status epilepticus, including nonconvulsive status epilepticus [MK]
  • Objective 4: Recognize features of the normal EEG, including normal variant patterns [MK]
  • Objective 5: Recognize physiologic and instrumental artifacts, and distinguish form EEG patterns [MK]
  • Objective 6: Improve teaching skills while lecturing neurology residents and medical students in EEG testing [MK, ICS, PBLI]
  • Objective 7: Demonstrate proficiency in effective interpersonal and communication skills with professional associates and other health care providers, particularly those referring patients for EEG testing [ICS, PROF]
  • Objective 8: Demonstrate proficiency in using information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic intervention [PBLI]

Evoked Potentials

Faculty Supervisors: Paul Kent, MD, Anil Mendiratta, MD and the rotating attending.

The goal of the evoked potential rotation is to provide trainees with the necessary background to interpret and direct recording of standard visual, brainstem auditory, and short-latency somatosensory evoked potentials. Trainees will be provided with a comprehensive knowledge of instrumentation, the principles of signal averaging, basic visual, somatosensory, and auditory physiology, anatomy and related neuroscience.

By the end of the academic year, Fellows should be able to:

  • Objective 1: Interpret evoked potential recordings in adults and children [MK]
  • Objective 2: Utilize knowledge of electrical safety to insure safe recording conditions, including in patients with indwelling catheters and electrodes [MK]
  • Objective 3: Relate evoked potentials abnormalities of specific neurological diseases, especially demyelinative and degenerative disorders [MK]
  • Objective 4: Identify waveforms used for clinical interpretation of visual, auditory and somatosensory evoked potentials. Specify criteria for abnormality of evoked potential recordings [MK]
  • Objective5: Identify physiologic and instrumental artifacts in evoked potential recording, and distinguish from evoked potential wave forms [MK]
  • Objective 6: Demonstrate proficiency in effective interpersonal and communication skills with professional associates and other health care providers [ICS]
  • Objective 7: Demonstrate proficiency in using information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic intervention [PBLI]

Adult ICU Continuous EEG

Faculty Supervisors: Rotating attending

The goal of the adult ICU Continuous EEG rotation is to provide trainees with the knowledge for the use of continuous digital video-EEG in the context of acute brain injury, encephalopathy, and coma. Trainees will have extensive knowledge of basic EEG patterns seen in coma and encephalopathy, quantitative EEG trending for recognition of acute brain events including seizures, ischemia, hemorrhage, and vasospasm. Trainees will also learn the role of EEG in multimodality monitoring in acute brain injury patients, both with scalp EEG and intracranial EEG and the use of video-EEG recording to formulate specific treatment strategies in complex critically ill patients.

By the end of the academic year, Fellows should be able to:

  • Objective 1: Interpret continuous video-EEG monitoring studies in adults and children and manage the findings, recognizing the indications and limitations of continuous digital video-EEG monitoring in critically ill patients of all ages [MK]
  • Objective2: Recognize and treat non-convulsive seizures and non-convulsive status epilepticus [MK]
  • Objective 3: Design and apply specific quantitative EEG protocols for trending and identifying acute brain events, including measures of rhythmicity, asymmetry, amplitude, power and alpha-delta ratios, and use of compressed spectral array [MK]
  • Objective 4 Recognize and manage post-anoxic coma and post-anoxic myoclonic status epilepticus [MK]
  • Objective 5: Demonstrate proficiency ineffective interpersonal and communication skills with professional associates and other health care providers [ICS, PROF]
  • Objective 6: Demonstrate proficiency in using information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic intervention [PBLI]

Adult EMU

Faculty Supervisors: Rotating attending

In the adult EMU rotation trainees are provided with the knowledge of the use of video-EEG in the context of comprehensive evaluation of adult patients with paroxysmal phenomena, including epilepsy. Trainees learn basic electronics, computer skills, and data reduction techniques necessary for effective and efficient long-term monitoring, digital EEG and polygraphic methods, the clinical and electrographic correlates of various paroxysmal behaviors, especially the features that allow distinguishing between epileptic and non-epileptic phenomena in adults.

By the end of the academic year, Fellows should be able to:

Objective 1: Interpret video-long term monitoring studies in adults and intracarotid amytal testing [MK]

Objective 2: Utilize knowledge of electrical safety to ensure safe recording conditions, including in patients with intracranial electrodes [MK]

Objective 3: Recognize electrographic patterns corresponding to focal and generalized seizures in adults [MK]

Objective 4: Identify time and location of ictal onset on scalp and intracranial recordings in adults [MK]

Objective 5: Relate clinical semiology to electrographic recordings in the diagnosis of epilepsy syndromes in adults [MK]

Objective 6: Plan treatment including respective surgery based on video-EEG long term monitoring studies in adults, along with other neuro-diagnostic data [MK]

Objective 7: Demonstrate proficiency in using information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic intervention [PBLI]

Objective 8: Demonstrate the ability to interact and communicate with patients with respect, compassion and integrity. In a manner that is sensitive to each person’s age, gender, cultural, economic and social

circumstances [ICS, PROF, PC]

Objective 9: Demonstrate understanding of the complexities of the health care system to advocate for quality of patient care and partner with other professional associates to coordinate best possible care [SBP, PROF, PC]

Objective 10: Demonstrate proficiency regarding cost-effective treatment without compromising quality of care [SBP, PC]

Objective 11: Demonstrate proficiency in billing compliance, risk management, HIPPA compliance and other regulatory requirements [SBP]

Pediatric EMU

Faculty Supervisors: Cigdem Akman, MD, Danielle McBrian, MD, and rotating attending

In the pediatric EMU rotation trainees are provided with the knowledge of the use of video-EEG in the context of comprehensive evaluation of children, patients with paroxysmal phenomena, including epilepsy. Trainees learn basic electronics, computer skills, and data reduction techniques necessary for effective and efficient long-term monitoring, digital EEG and polygraphic methods, the clinical and electrographic correlates of various paroxysmal behaviors, especially the features that allow distinguishing between epileptic and non-epileptic phenomena in children. Trainees also learn electroclinical correlates of different seizure types and various epilepsy syndromes in children as well as the use of video-EEG recording to formulate specific treatment strategies in children

By the end of the academic year, Fellows should be able to:

  • Objective 1: Interpret video-long term monitoring studies in children and intracarotid amytal testing [MK]
  • Objective 2: Utilize knowledge of electrical safety to ensure safe recording conditions, including inpatients with intracranial electrodes in children [MK]
  • Objective 3: Recognize electrographic patterns corresponding to focal and generalized seizures in children [MK]
  • Objective 4: Identify time and location of ictal onset on scalp and intracranial recording in children [MK]
  • Objective 5: Relate clinical semiology to electrographic recording in the diagnosis of epileptic syndromes in children [MK]
  • Objective 6: Plan treatment including respective surgery based on video-EEG long term monitoring studies in children, along with other neuro-diagnostic data [MK]
  • Objective 7: Demonstrate proficiency in using information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic intervention [PBLI]
  • Objective 8: Demonstrate the ability to interact and communicate with patients and their families with respect, compassion and integrity. In a manner that is sensitive to gender, cultural, economic and social diversity [ICS, PROF, PC]
  • Objective 9: Demonstrate understanding of the complexities of the health care system to advocate for quality of patient’s care and partner with other professional associates to coordinate best possible care [SBP, PROF, PC]
  • Objective 10: Demonstrate proficiency regarding cost-effective treatment without compromising quality of care [SBP, PC]
  • Objective 11: Demonstrate proficiency in billing compliance, risk management, HIPPA compliance and other regulatory requirements [SBP]

Sleep Disorders

Faculty Supervisor: Carl Bazil, MD, PhD and Rachael Benson, MD

The goal of the sleep disorder rotation is to provide trainees with overview knowledge of normal human chronobiology, clinical evaluation of sleep disorders, and the neurophysiological tests available to assess suspected sleep disorders appropriately. Emphasis will be placed on disorders producing excessive day time somnolenceor insomnia, and on the use of polysomnography and multiple sleep latency tests to diagnose and manage specific sleep disorders.

By the end of the academic year, Fellows should be able to:

  • Objective 1: Demonstrate proficiency in scoring, reading and interpreting polysomnograms (PSGs) in children and adults with obstructive or central sleep apnea, sleep-related hypoventilation, Cheyne-Stokes respiration, insomnia, restless legs, periodic limb movements, disorders of arousal, REM sleep behavior disorder, sleep-related epilepsy, dementia, narcolepsy-cataplexy, idiopathic hypersomnia, and neuromuscular disorders [MK]
  • Objective 2: Select which, where, and when patients should have sleep studies to evaluate their complaints and how their sleep and medication schedules should be adjusted to avoid confounding factors altering the testing results [MK]
  • Objective 3: Score, read and interpret Maintenance of Wakefulness test (MWT), Multiple sleep latency test (MSLT), Oximetery) in the context of the patient’s sleep/wake complaints, sleep diary, PSG, and medication use [MK]
  • Objective4: Select polysomnographic montages which enhance diagnosis of nocturnal hyper apnea, sleep apnea in children, epileptic and non-epileptic parasomnias, restless legs [MK]
  • Objective 5: Demonstrate proficiency in using information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic intervention [PBLI]
  • Objective 6: Demonstrate proficiency in effective interpersonal and communications skills with professional associates and other health care providers, particularly those referring patients for sleep evaluations [ICS, PROF]

Intraoperative Monitoring

Faculty Supervisor: Anil Mendiratta, MD and Paul Kent, MD

The goal of this rotation is to provide clinical neurophysiological trainees with the necessary background and skills to direct and interpret electrocorticography, and use of sensory, and motor evoked potentials. Emphasis is on the common surgical procedures that routinely use electrophysiological techniques intraoperatively, the technical requirements for reliable monitoring, how to develop the best strategies to achieve the electrophysiological objective in a particular patient, and experience of real-time problem solving. Trainees will become knowledgeable about the indications for intraoperative monitoring, the effectiveness of various anesthetic agents, and differentiating between transient, insignificant changes and those of surgical and clinical importance.

By the end of the academic year, Fellows should be able to:

  • Objective 1: Select intraoperative monitoring modality appropriate for various spinal, spinal cord, brainstem, hemisphere and vascular surgical procedures [MK]
  • Objective 2: Suggest anesthetic techniques appropriate for various spinal, spinal cord, brainstem, hemispheral and vascular surgical procedures, and identify effects of anesthetic and relaxant agents on monitored signals [MK]
  • Objective 3: Utilize knowledge of electrical safety to insure patient safety during intraoperative monitoring [MK]
  • Objective 4: Specify criteria for significant intraoperative changes in MEPs, SSEPs and BAEPs, and be able to identify them in real-time [MK]
  • Objective 5: Interpret pedicle screw integrity testing [MK]
  • Objective 6: Identify cranial and peripheral nerves intraoperatively using free run and triggered methods [MK]
  • Objective 7: Recognize injury patterns on free run EMG recordings for cranial and peripheral nerves [MK]
  • Objective 8: Identify EEG changes requiring shunting during carotid endarterectomy [MK]
  • Objective 9 Demonstrate proficiency ineffective interpersonal and communication skills particularly with anesthesiologists and surgeons during intraoperative monitoring [ICS, PROF]
  • Objective 10: Demonstrate proficiency in using information technology to gather the most up-to-date scientific evidence to make informed decisions regarding intraoperative monitoring [PBLI]

Electromyography (EMG) Laboratory

Faculty Supervisor: Louis Weimer, MD

During the Electromyography (EMG) laboratory rotation, trainees acquire detailed knowledge of and experience in the performance and interpretation of EMG, nerve conduction and related studies. During this rotation, EMG track trainees will also be exposed to various procedures for evaluating the autonomic nervous and motor control systems.

At the end of the academic year, Fellows should be able to:

  • Objective 1: Perform basic and selected advanced nerve conduction studies, including motor, sensory, and long latency reflexes [MK]
  • Objective 2: Interpret nerve conduction study waveforms and recognize common technical pitfalls and artifacts [MK]
  • Objective 3: Utilize knowledge of electrical and needle safety to ensure safe recording conditions for the patient and physician, including studies of patients with indwelling lines, infections, pacemakers, and anticoagulation therapy [MK]
  • Objective 4: Perform needle EMG studies of a wide variety of skeletal muscles and accurately gather information on spontaneous activity, motor unit potential characteristics, and voluntary recruitment patterns [MK]
  • Objective 5: Identify and interpret nerve conduction waveform patterns related to acquired axonal and demyelinating neuropathies, inherited neuropathies, mononeuropathies, plexopathies, conduction block, and peripheral nerve injury [MK]
  • Objective 6: Recognize normal variant nerve conduction study and EMG patterns [MK]
  • Objective 7: Recognize and interpret EMG patterns related to myopathy, peripheral neuropathy, motor neuropathy, radiculopathy, and plexopathy [MK]
  • Objective 8: Recognize common anatomical variants that my lead to erroneous diagnostic interpretation [MK]
  • Objective 9: Perform and interpret repetitive nerve conduction studies related to the diagnosis of neuromuscular junction disorders [MK]
  • Objective 10: Understand the pathophysiology of common autonomic tests [MK]
  • Objective 11: Distinguish differences between parasympathetic, adrenergic, and sudomotor measures. Understand the common clinical applications of autonomic testing [MK]
  • Objective 12: Describe the basic procedures for performing transcranial magnetic motor evoked potential studies [MK]
  • Objective 13: Understand the clinical applications of Magnetic stimulation testing –Perform clinical correlation of test findings in PLS and ALS patients [MK]
  • Objective 14: Demonstrate proficiency in using information technology to gather the most up-to-date scientific evidence to make informed decisions regarding performance and interpretation of EMG, nerve conduction and related studies [PBLI]
  • Objective 15: Demonstrate proficiency in effective interpersonal and communications skills with other health professionals [ICS, PROF]
  • Objective 16: Demonstrate the ability to interact and communicate with patients and their families with respect, compassion and integrity. In a manner that is sensitive to gender, cultural, economic and social circumstances [ICS, PROF, PC]