Epilepsy & EEG Fellowship

Epilepsy/EEG (2 Years): This fellowship includes one year of an ACGME-accredited Clinical Neurophysiology Fellowship, followed by a second year of an ACGME-accredited Epilepsy Fellowship. Training includes extensive Video-EEG monitoring, intracranial EEG, surgical and medical treatment of epilepsy, epilepsy comorbidities such as neuropsychiatry, brain mapping, inpatient and outpatient epilepsy, EEG in all settings (ICU, inpatient, outpatient), brain stimulation for epilepsy, evoked potentials and sleep medicine/polysomnography, all including adults, children and neonates. All fellows are encouraged to participate in research. There are typically a total of four Epilepsy/EEG fellows (2 first year CNP, 2 second year Epilepsy) in this program. Of note, there is occasionally a one-year opening for either Clinical Neurophysiology or Epilepsy Fellowship within the program. Please email Fellowship Director Adithya Sivaraju, MD, MHA to inquire about this availability.

The Clinical Neurophysiology and Epilepsy fellowship has moved to a standardized matching process using ERAS for the application and the NRMP to provide matching services. In ERAS, please be sure to include:

• Personal statement: 1-2 pages outlining your reasons for applying, career goals, and strengths you will bring to the program
• Three letters of reference: We have no preference regarding who provides your letters, but typically a Neurology Residency Program Director is included. Reflect on who will be the best judge of your career potential, interest in our field, and to comment on your clinical acumen, as well as accomplishments.
• Resume as included in the relevant sections of the ERAS Application
• A photo within ERAS
• Of note, applicants should be neurology board-eligible.

Critical Care EEG (1 Year): This fellowship is often completed in conjunction (typically before or after) a neurocritical care fellowship (at Yale University or elsewhere), but the funded fellowship requires completion of an accredited neurology residency program. However, if there is clinical or research interest in ICU-EEG, an applicant not completing Neurocritical Care Fellowship would certainly be considered. The fellow will learn basic and advanced EEG interpretation related to critical care. Fellows will gain expertise in quantitative EEG techniques, real-time brain monitoring/neurotelemetry, ischemia/vasospasm detection, controversial patterns, intracranial EEG and multimodality monitoring. They will also be exposed to the basics of non–critical care EEG, including interpretation of outpatient EEGs and epilepsy video/EEG monitoring. Fellows are also expected to become experts in managing seizures in the critically ill. This fellowship will include participation in the Critical Care EEG Monitoring Research Consortium, and fellows are encouraged to participate in original research. There is typically one Critical Care EEG fellow per year. After completion of this fellowship, fellows will be eligible for the American Board of Clinical Neurophysiology (ABCN) critical care EEG boards.

The Critical Care EEG fellowship does NOT use the ERAS system and requires the following be sent directly to Fellowship Coordinator Peggy McLaughlin and Dr. Sivaraju.

1. Paper application
2. A letter of interest: Typically, 1-2 pages outlining the reasons applying for the critical care program as well as you career goals and how you plan to use this training in your future endeavors.
3. Updated CV
4. Three letters of reference: We have no preference regarding who providers your letters, but typically a neurology residency program director or neurocritical care fellowship director is included. Reflect on who will be the best judge of your career potential, interest in our field, and to comment on your clinical acumen, as well as accomplishments.
5. If completed a residency outside of the United States or Canada, demonstrated passage of all USMLE Step Examinations so that practice of clinical medicine is allowed.

Questions regarding the application should be emailed to Peggy McLaughlin and Dr. Sivaraju.

ICU-EEG Research (1-3 years, unfunded): A non-funded ICU-EEG research fellowship exists, directed by Dr. Lawrence Hirsch. International applicants are welcome, but applicant must be fluent in English. Prior experience with EEG required, and evidence of research potential or track record is necessary. This will be a full-time research fellowship with projects related to critical care EEG. Please email Dr. Hirsch, academic division chief of Epilepsy, to inquire about the availability in this program.

Our fellowship program is designed to provide comprehensive clinical training across a variety of settings, ensuring that you develop the skills needed to excel in all aspects of epilepsy care. The clinical core of our program includes the following key rotations:

Adult Epilepsy Monitoring Unit:
With eight beds dedicated to adult patients (expanding to 12 in the forthcoming Neuroscience Tower), the Epilepsy Monitoring Unit (EMU) is where patients are admitted for pre-surgical evaluation, including intracranial EEG monitoring and spell characterization. Working closely with our dedicated EMU Advanced Practice Provider, fellows will be deeply involved in the comprehensive pre-surgical workup, including intracranial EEG monitoring. This rotation provides essential experience in identifying candidates for epilepsy surgery and tailoring surgical plans.

Pediatric Epilepsy Monitoring Unit:
The three-bed pediatric EMU (also likely to increase in the next few years) focuses on the evaluation of younger patients who require pre-surgical workup or further characterization of their seizures/events. This rotation offers fellows unique insights into the management of epilepsy in pediatric populations, including the nuances of intracranial EEG in children and neonates.

Stimulation Mapping:
Our institutional approach to tailoring an intracranial study – whether using SEEG or a combined approach involving both surface and depth sampling – allows for not only detailed functional mapping of critical areas such as language and motor functions, but also systematic seizure induction and comprehensive mapping of seizure networks. This hands-on experience is complemented by a progressive lecture course designed to advance fellows’ understanding from foundational concepts to more complex applications. This ensures they gain a thorough and practical understanding of stimulation mapping techniques.

ICU EEG:
During this rotation, fellows are responsible for reading all non-elective inpatient EEGs, with a focus on those performed in the neurological, medical, and surgical ICUs at Yale New Haven Hospital. This experience is critical for developing proficiency in ICU EEG interpretation, including the use of quantitative EEG, DCI monitoring and intracortical EEG interpretation in acute brain injury.

Outpatient EEG:
The objective of this rotation is to learn the basic principles of clinical neurophysiology that can be applied to interpreting outpatient EEG studies. Fellows will obtain exposure to various forms of EEG monitoring, including standard outpatient EEGs, ambulatory EEGs, and home video EEGs.

Continuity Clinic:
Fellows are responsible for managing their own patients in the Continuity Clinic, held for one half-day weekly. This experience allows fellows to follow patients longitudinally for two years, providing ongoing epilepsy care and management. Fellows will also have the opportunity to work up potential surgical candidates, gaining hands-on experience in the pre-surgical evaluation process.

Specialty Clinics

Neuromodulation Clinic:
In this clinic held most Monday mornings, fellows gain hands-on experience in managing neuromodulation devices, primarily Responsive Neurostimulation (RNS) and Deep Brain Stimulation (DBS) (VNS is mostly handled during regular epilepsy clinics). This hands-on exposure is crucial for developing the expertise needed to manage these advanced therapeutic options, preparing fellows for independent practice upon graduation.

Post Acute Symptomatic Seizure (PASS) Clinic:
First conceptualized at Yale, the PASS clinical pathway has become a model of care now implemented across several major academic centers. This clinic is specifically designed for managing patients with acute symptomatic seizures and/or acute epileptiform patterns. Patients identified at hospital discharge are referred to the PASS Clinic for post-hospital discharge follow-up. The primary goal of this clinic is to prevent the unnecessary long-term use of antiseizure medications (ASMs) by carefully evaluating and managing these patients in the post-acute setting. The PASS pathway has resulted in several impactful publications.

Epilepsy and Pregnancy Clinic:
At our Epilepsy and Pregnancy Clinic, we provide comprehensive, multidisciplinary care tailored to the unique needs of women with epilepsy who are planning a pregnancy, are currently pregnant, or are in the postpartum period. This includes careful selection and adjustment of ASMs to minimize risks to the fetus while maintaining seizure control for the mother. In collaboration with Maternal-Fetal Medicine, our clinic brings together experts in neurology, obstetrics, and maternal-fetal medicine to provide coordinated care.

Psychogenic Non-Epileptic Attack (PNEA) Clinic:
Realizing the unmet need for cognitive behavioral therapy (CBT) in patients with confirmed Psychogenic Nonepileptic Attacks (PNEA), our division started a dedicated PNEA Clinic. With multiple locations, this clinic utilizes trained advanced practitioners and one attending who is both a psychiatrist and epileptologist to provide weekly CBT sessions, addressing a crucial gap in the management of PNEA.

You will have access to a wide range of research projects, from basic science to clinical trials, with mentorship from leading experts in the field. Fellows are assigned an individual mentor based on their research interests. The goal of this mentorship is to guide fellows in developing and conducting research projects that not only contribute to the field, but also lead to presentations at national and international conferences, culminating in the publication of their findings in peer-reviewed journals.

Our program offers extensive research opportunities that allow you to explore various aspects of epilepsy care, including:

Existing Databases:
You will have access to a wealth of data through our existing databases, including ICU EEG, Antiseizure Medication, Status Epilepticus, Acute Symptomatic Seizures and Epilepsy Surgery databases. These resources often serve as the starting point for many trainees for conducting impactful research.

Clinical Trials and Collaborative Research:
Engage in cutting-edge clinical trials and collaborate with multidisciplinary teams across Yale, including experts in neurology, neurosurgery, radiology, cognitive neuroscience, and psychiatry. This collaborative environment fosters innovation and provides fellows with the opportunity to participate in research that can directly influence patient care and the future of epilepsy treatment. We invite you to explore the Epilepsy and EEG Research website, which outlines the outstanding research stemming from various labs affiliated with the division of epilepsy and ongoing clinical trials.