Training of neurology residents in epilepsy and EEG comprises an essential component of the overall training scheme of the UF neurology residency program. Dr. Maria Bruzzone heads the resident training effort on behalf of the Division’s faculty. Epilepsy rotations are divided into two blocks of four weeks each, Epilepsy I and Epilepsy II. The former occurs usually within the first six months of the PGY2 year, and the second four weeks is taken sometime during the PGY3-4 years. Residents with a particular interest in epilepsy may choose to spend extra elective time to gain more experience or pursue a research topic. In general, we aim to impart knowledge that is clinically important and comprehensive for the everyday practice of neurology, yet succinctly conveyed. In addition, being a tertiary referral center, we also expose trainees to the challenges of complex and surgical epilepsy syndromes, so that they may glimpse the excitement and promise of this rapidly-evolving neurology subspecialty. In addition, all new entering residents are provided a set of lectures dubbed the ‘epilepsy bootcamp’ during their first week that equips them to appropriately request investigations and manage seizures in the emergency room or wards.
The goals of the Epilepsy I and Epilepsy II rotations are
- Basic competency with EEG reading (milestone based evaluations)
- Epilepsy I rotation: physiological patterns in wake and sleep, normal variants, introduction to the abnormal EEG
- Epilepsy II rotation: emphasis on pathological patterns based on the 2021 ACNS ICU/EEG nomenclature
- Recognition of seizures and status epilepticus and initiation of therapy
- Epilepsy I: basics of identification of seizures and status epilepticus and approach to treatment in the inpatient setting
- Epilepsy II: management of refractory, super refractory, convulsive and non- convulsive status epilepticus
- Inpatient management in the epilepsy monitoring unit (EMU)
- Epilepsy I: basics of scalp video EEG monitoring and diagnostic workup of paroxysmal spells
- Epilepsy II: electroclinical syndromes, workup of refractory epilepsy, intracranial monitoring and brain mapping
Residents spend their time on both of the epilepsy services every day: the EMU service that deals with hospitalized patients and any inpatient procedures and the EEG service that is responsible for interpretation of for short EEGs (stats and routines), long-term monitoring, ambulatory, day lab video-EEGs and evoked potentials. Resident didactic conferences are held every day at noon. Epilepsy specific didactics take place on Wednesday mornings and Friday mornings. Residents are also welcome to the divisional patient management conferences on Monday afternoons and Tuesday mornings.
A sample weekly time-table might be: