Epilepsy and EEG

Overview

Yale School of Medicine and Yale-New Haven Hospital currently have a two-year epilepsy fellowship that follows neurology postgraduate training. Fellowship can be one year in special situations, but this decision must be made within three months of the start of fellowship and cleared with the fellowship director ahead of time. Most of the time, however, the fellowship includes two years and encompasses clinical training in an inpatient and outpatient setting, as well as research which may be basic or clinical. Fellows assume a considerable amount of clinical responsibility including inpatient evaluation and admission, orders including decisions on antiepileptic drug withdrawal, sleep deprivation, and other activation procedures for monitoring, construction of montages for printing and review of all recorded EEG video data, screening for artifactual results, presentation of results to the Epilepsy Attending, and formulation of results of the monitoring session. The fellows gain expertise in antiepileptic drug manipulations, pharmacokinetics and pharmacodynamics, as well as interpretation of continuous video EEG. The latter includes application of additional scalp electrodes, specialized electrodes including sphenoidals, intracranial, depth, and subdural EEG electrodes, interpretation of sleep and activated EEG in an inpatient setting, and utilization of all these skills in the study of both children and adults. Studies are done to evaluate ongoing epilepsy with difficult management issues, as well as diagnostic situations in which epilepsy or non-epileptic seizures are among the diagnostic possibilities. The inpatient monitoring is supervised by full-time Yale epilepsy faculty. The fellows work extensively and directly with the epilepsy faculty in their clinical training.

In addition, the fellows receive more formal education in the setting of a specific lecture series covering a broad range of topics in epilepsy evaluation, diagnosis, categorization, treatment and mechanisms. Fellows also are encouraged to and mentored through research projects of their choice. These may include basic and/or clinical areas as the specific interests of the fellow dictate. Research projects are supported by and mentored by epilepsy faculty who will assume a key role in designing and directing the research of the fellow. It is our hope that the fellows will accomplish a sufficient amount to present their work at the American Epilepsy Society, the American Academy of Neurology, Child Neurology Society, and Society for Neuroscience annual meetings and publish their work.

The fellowship includes, at any given time, three epilepsy neurology fellows (a mixture of first and second year). Sometimes up to four are present because of independent funding for additional fellows. In addition, neurosurgery fellows and visiting scholars from other countries join this group at various times.

The fellowship has existed for nearly three decades and from this environment and setting, has produced multiple academic and practicing neurologists with expertise in epilepsy and its subtypes, its evaluation and treatment, and its investigation. Currently, there is no accreditation or certification for epilepsy, but the American Academy of Neurology and its Epilepsy Section are working to accomplish epilepsy subspecialty recognition. This fellowship is specifically for epilepsy training, not clinical neurophysiology, although extensive training and education in EEG is included.