Epilepsy Curriculum

Epilepsy fellows will have various rotations at the NYU Langone Medical Center, a large 879-bed hospital located on 1st Avenue on the East Side of Manhattan. The NYU Comprehensive Center is a Level 4 epilepsy center, and is among the largest epilepsy programs in the United States. In addition to adult and pediatric inpatient video-EEG monitoring units, NYULMC also possesses a robust epilepsy surgical program, epilepsy consult service, and outpatient clinic.

Epilepsy fellows spend the 12 months of their fellowship at NYU-Langone Medical Center and 3 months at The Hospital for Joint Diseases. One month of vacation time is provided in addition to one month of elective time.

EEG/Epilepsy Experience

Inpatient Services:

The Epilepsy Fellowship is directed by Dr. Patricia Dugan. During the EEG/Epilepsy training months, fellows will rotate through several core services and gain extensive clinical experience with both adult and pediatric video-EEG monitoring, invasive intracranial monitoring, and epilepsy consults in both ICU and non-ICU settings. NYU-Langone Medical Center boasts one of the largest video-EEG monitoring units in the country with 18 state-of-the-art hard-wired beds in the adult unit and 8 hard-wired beds in the pediatric unit; this provides fellows a vast array of seizures 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, performing electrode implantation and/or surgical resections on approximately 60-80 patients annually.

During their time at NYU Langone Medical Center, fellows will rotate for 1-month intervals on the adult video-EEG service, Pediatric Service, Consult Service, and the surgical service. During their time on the adult video-EEG monitoring unit, which is located on the 12th floor of the Health Care Center (HCC-12) Building, fellows will practice and perfect their EEG-reading skills during their daily morning review of records with the service attending.  EEG review is done in the morning directly with the service attending to provide one-on-one interaction and feedback on EEG review skills. They will also learn the verbiage necessary to write a proper EEG report, a skill they will use throughout their careers as clinical neurophysiologists. Fellows will encounter a variety of patient cases on the adult inpatient service, including but not limited to: temporal lobe epilepsy, frontal lobe and other extra-temporal epilepsies, multifocal epilepsy, primary generalized epilepsy and symptomatic generalized epilepsy, Lennox-Gastaut Syndrome, and cases of focal status epilepticus. Indications for admission include but are not limited to: Differential diagnosis, characterization, pre-surgical evaluation, and the acute management of seizure exacerbation. Fellows can learn a tremendous amount from the wide array of cases and underlying etiologies observed on the epilepsy unit, including brain tumors, stroke, malformations of cortical development, and CNS-inflammatory diseases such as lupus encephalitis and NMDA-receptor antibody encephalitis. Non-epileptic seizures are also routinely encountered, as well as other psychiatric manifestations of refractory epilepsy. We have a dedicated psychiatrist who works on the unit and consults on all inpatients in need of psychiatric evaluation and care. In addition, our neuropsychologists are an active part of the HCC-12 team, and are invaluable in providing comprehensive patient assessments. The clinical exposure on the HCC-12 service is tremendous and will contribute greatly to the epilepsy fellows’ knowledge base. On the adult floor, around 80-90 patients are admitted for monitoring per month.

Fellows will learn to read pediatric recordings while on the inpatient pediatric video-EEG service, working directly with our pediatric epileptologists. On this rotation, as with the adult epilepsy monitoring unit, EEG review will be done directly with the attending physician. The pediatric unit reviews around 40-60 patients per month including neonatal cases. Cases often 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 non-epileptic etiologies.

On the consult service, fellows will encounter a wide range of epilepsy clinical scenarios. They will have the opportunity to manage routine “bread-and-butter” cases, providing guidance with antiepileptic drug management and in some cases make new diagnoses. They will also take part in the management of acutely ill patients in the medical, cardiac, surgical, and neurosurgical Intensive Care Units, which can provide some of our more challenging epilepsy cases.

The epilepsy surgical (or “Special Procedures”) service is an excellent example of multiple disciplines working in synchrony to provide comprehensive patient care. Fellows will work with the attending of service to interpret intracranial electrode recordings and coordinate mapping procedures and intracarotid amobarbital procedures (aka the Wada test). Annually, 70-90 patients undergo epilepsy surgery and invasive monitoring at NYU Langone with 20-30 cortical mapping procedures (bedside), 15-30 intra-operative mapping procedures and 40-50 Wadas. Fellows will also become adept at creating intracranial electrode montages and will lead the weekly Multidisciplinary Conference presenting cases of patients being considered for epilepsy surgery.

Epilepsy fellows also have an Elective month and are encouraged to use this time to pursue individual research interests or gain additional experience in neurostimulation, sleep medicine, intraoperative and extraoperative procedures, and other areas of clinical neurophysiology. Lastly, during the Outpatient Ambulatory Rotation, EEG track fellows have the opportunity to see outpatients with a variety of epilepsy faculty.  This rotation exposes fellows to different approaches and styles of outpatient epilepsy management, and to a wide array of epilepsy disorders.  During this rotation fellows also interpret both routine and ambulatory EEG studies under the guidance of faculty members.  There is also ample opportunity to teach neurology residents and students who might be rotating through the clinic.

EEG Fellows' Continuity Clinic:

All EEG Fellows will participate in outpatient epilepsy clinic, which is held once a week. The clinic is an excellent opportunity for fellows to flex their outpatient management skills with patients of their own, who they will follow throughout the year ensuring continuity of care. An epilepsy attending staffs the clinic, sees all patients with the fellows, and discusses patient evaluation and management plans. Nursing staff helps to coordinate patient care. Interpreter services are also available when needed.

Goals:

By the time the first year of epilepsy training is complete, fellows will be competent in adult and pediatric EEG interpretation and documentation; outpatient management of epilepsy; acute inpatient epilepsy management; and management of the surgical patient. All fellows should feel comfortable understanding when to refer a patient for surgery, the necessary components of a tailored comprehensive surgical evaluation, what type of surgery may be required, and a patient’s candidacy for neurostimulation. These skill sets will foster the development of a very capable clinical and academic epileptologist. After this year of training, fellows are both eligible and encouraged to take the Epilepsy board examination offered through the American Board of Psychiatry and Neurology.