Clinical Neurophysiology Fellowship—EEG Track
In NYU Langone’s Department of Neurology, our clinical neurophysiology fellowship’s electroencephalography (EEG) track produces physicians who are skilled in adult and pediatric EEG interpretation and documentation, outpatient management of epilepsy, acute inpatient epilepsy management, intensive care unit (ICU)-level management of status epilepticus and other EEG-guided care protocols, and management of surgical patients by using skills such as interpreting intracranial recordings. By the end of the program, our fellows understand when it is appropriate to refer a patient for surgery and what type of surgery may be required.
Our fellows also develop clinical competency in a second subspecialty area of clinical neurophysiology, sleep medicine. There is a significant overlap between the world of epilepsy and sleep medicine. Sleep disorders can result in worsening of seizures, and can sometimes be misconstrued as seizures themselves. Our fellowship offers a two month rotation for EEG-track clinical neurophysiology fellows to spend time at NYU Langone’s Comprehensive Epilepsy Center—Sleep Center, where they learn the basics of polysomnography. Fellows also are exposed to multiple sleep latency test (MSLT) interpretation, and gain clinical outpatient exposure at the Comprehensive Epilepsy—Sleep Center.
You also spend one month on a Subspecialty Plus Rotation, where you are exposed to the other clinical neurophysiology subspecialties. During the Subspecialty Plus Rotation, you spend approximately 2.5 days per week rotating with the electromyography (EMG) faculty at our conveniently located NYU Langone Ambulatory Care Center East 38th Street, focusing on nerve conduction studies (NCSs)/EMG; one to two half-days a week observing intraoperative monitoring (IOM) studies at Tisch Hospital; one to two half-days a week in the Evoked Potential (EP) Lab; and one half-day a week devoted to self-study via e-tutorials and other essential reading materials.
This training experience fosters your development into a very capable clinical neurophysiologist and epileptologist. It prepares you for a career in either academia, private practice, or a combination thereof.
In addition to the above clinical rotations, you spend one half-day per week attending to the outpatient continuity clinic. We also provide one month of vacation time, which is typically taken in four separate one-week blocks across the year. Financial support is provided for the attendance of one academic meeting during the year.
After this year of training, fellows are both eligible and encouraged to take the clinical neurophysiology board exam offered through the American Board of Psychiatry and Neurology. At present, the examination is offered on an alternating-year basis.
The EEG–Epilepsy Experience
Fellows on our EEG track gain extensive experience in working with both adults and children with epilepsy and seizure disorders.
During the EEG/epilepsy training months, fellows rotate through several core services and gain extensive clinical experience with both adult and pediatric video EEG monitoring, invasive intracranial monitoring, other special procedures such as bedside and intraoperative mapping procedures, and epilepsy consults in both ICU and non-ICU settings. Tisch Hospital and Kimmel Pavilion are home to two of the largest video EEG monitoring units in the country. Our inpatient video-EEG monitoring adult and pediatric services, which boast 20 and 12 hard-wired beds, respectively, are located in NYU Langone’s state-of-the-art Kimmel Pavilion. This provides fellows a vast array of seizure-related and electrographic data from which to learn.
We are also proud to feature one of the most active epilepsy surgical programs in the United States, typically performing 60 to 80 surgical procedures (electrode implantations and surgical resections) annually.
Inpatient Services Rotation
During your time at Tisch Hospital and Kimmel Pavilion, you rotate at one-month intervals on the adult video EEG service, pediatric service, consult service, and surgical service. While on the adult video EEG monitoring unit, you practice and perfect your EEG-reading skills during daily morning review of records with the attending physician, which is an opportunity for one-on-one interaction and feedback on EEG review skills.
You also learn the language necessary to write a proper EEG report, a skill used throughout a clinical neurophysiologist’s career. You encounter a variety of conditions on the adult inpatient service, including temporal lobe epilepsy, frontal lobe and other extra-temporal epilepsies, multifocal epilepsy, primary generalized epilepsy and symptomatic generalized epilepsy, Lennox-Gastaut syndrome, and focal status epilepticus, among other conditions. Examples of indications for admission include differential diagnosis, characterization, presurgical evaluation, and the acute management of seizure exacerbation.
As a fellow, you learn much from the wide array of cases and underlying etiologies observed on the epilepsy unit, including brain tumors, stroke, malformations of cortical development, and central nervous system inflammatory diseases such as autoimmune encephalitis. Nonepileptic seizures are also routinely encountered, as are other psychiatric manifestations of refractory epilepsy.
We have a dedicated psychiatrist who works on the unit and consults on all cases involving inpatients in need of psychiatric evaluation and care. In addition, our neuropsychologists are an active part of our team and are invaluable resources in providing comprehensive patient assessments. On the adult floor, approximately 60 to 80 patients are admitted for monitoring every month. During this rotation, you also spend one hour each week reviewing findings from interesting EEG studies with our EEG technicians in the inpatient EEG lab, which serves as structured teaching time. You also have the opportunity to engage with rotating medical students and neurology residents and teach them all that you know about epilepsy and seizures.
You also learn to read pediatric EEG recordings while on the inpatient pediatric video EEG service, working directly with our pediatric epileptologists. On this rotation, as on the adult epilepsy monitoring unit, EEG review is performed directly with the attending physician. The pediatric unit typically reviews approximately 40 to 60 patients per month, including neonatal patients. Conditions often encountered include temporal and extra temporal neocortical epilepsies, infantile spasms, metabolic–neurodegenerative diseases, tuberous sclerosis complex, malformations of cortical development, hemimegalencephaly, absence seizures, benign rolandic seizures, status epilepticus, and nonepileptic etiologies.
On the consult service, you encounter a wide range of epilepsy-related clinical scenarios. You have the opportunity to manage routine “bread-and-butter” cases, provide guidance on antiepileptic drug management, and in some cases make new diagnoses. You also take part in the management of acutely ill patients in the medical, cardiac, surgical, and neurosurgical ICUs, where some of our more challenging epilepsy cases are found. Patients on the consult service can be monitored using a portable video EEG machine, and studies can be viewed remotely. Inpatient routine EEG studies are also the responsibility of the consult epilepsy fellow and attending. There is again ample opportunity for medical student and neurology resident teaching on this rotation.
The epilepsy surgical, or “special procedures,” service is an excellent example of comprehensive, multidisciplinary patient care. You work with the attending of service to interpret intracranial electrode recordings and coordinate mapping and intracarotid amobarbital procedures (the latter are also referred to as Wada tests). Annually, 70 to 90 patients have epilepsy surgery and invasive monitoring at NYU Langone, with 20 to 30 cortical mapping procedures at the bedside, 15 to 30 intraoperative mapping procedures, and 40 to 50 Wada tests. You will become adept at creating intracranial electrode montages and will lead the weekly multidisciplinary conference, presenting cases of patients being considered for epilepsy surgery.
Outpatient Services Rotation
The outpatient ambulatory rotation gives clinical neurophysiology EEG-track fellows the opportunity to see outpatients under the supervision of a variety of epilepsy faculty. This rotation also exposes you to different approaches and styles of outpatient epilepsy management, as well as to a wide array of epilepsy disorders. During the rotation, you also interpret outpatient routine and ambulatory EEG studies under the guidance of faculty members with the additional opportunity to teach neurology residents and medical students who might be rotating through the clinic.
EEG Fellows’ Continuity Clinic
EEG-track fellows participate in an outpatient epilepsy clinic held once a week. The clinic is an excellent opportunity for you to flex your outpatient management muscles with patients of your own, whom you follow throughout the year to ensure continuity of care. An epilepsy attending physician staffs the clinic, sees patients with you, and discusses patient evaluation and management. Nursing staff help to coordinate patient care, and interpreter services are also available when needed.
EEG track fellows are scheduled to take call at Tisch Hospital. On weeknights, you take call from home. You field calls from the hospital, as well as from outpatients. An attending physician is always on call with you, available to discuss problems and answer questions. You have online access to patients’ outpatient clinical records from home through the Epic electronic medical record system, and you are also able to review video EEG recordings through remote access, if needed. On-call fellows round in the hospital with the on-call attendings on weekends, but resume home call when the day’s work is complete.
Clinical Neurophysiology Fellowship Didactic Lecture Series
All clinical neurophysiology fellows are expected to attend regularly scheduled conferences that make up the clinical neurophysiology fellowship curriculum. Topics related to EEG, epilepsy, EMG and NCSs, sleep, EPs, IOM, and neuromuscular disease are covered across the year. Lectures are held every Thursday at 12:00PM, and are prepared and given by faculty for fellows; in the latter half of the year, the EMG-track fellow leads case presentations and discussions at the weekly conference, under attending physician supervision.
NYU Langone’s Comprehensive Epilepsy Center provides a weekly lecture series presented by faculty, visiting faculty, and fellows. This educational lecture series occurs every Wednesday morning at the Comprehensive Epilepsy Center and is considered protected time for fellows on the Tisch Hospital rotations. Invited lecturers from NYU Langone, as well as from other external facilities, lead the discussions, in addition to our own Comprehensive Epilepsy Center faculty.
Clinical neurophysiology fellows also have the opportunity to lead one journal club each year, which take place on Wednesday mornings at the Comprehensive Epilepsy Center, alternating with the other Wednesday morning conference lectures. Fellows also present a quality improvement project, which they may work on as a group across the year.