Program Description

Clinical Neurophysiology/EEG and Epilepsy Fellowships

Introduction: The University of Virginia (UVA) fellowships in clinical neurophysiology (CNP)/ EEG, and epilepsy are part of the FE Dreifuss Comprehensive Epilepsy Program in the Department of Neurology located in central Virginia at the foot of the Blue Ridge Mountains. The Department of Neurology has almost 50 clinical faculty, 16 fellows, and 26 residents. There are typically 4 to 6 fellows in the Epilepsy Program at a time, primarily in two-year fellowships.

Certification: The first year of fellowship is accredited by the ACGME as a clinical neurophysiology fellowship, with emphasis on EEG but containing exposure to clinical epilepsy, evoked potentials, , and EMG. Successful completion allows fellows to sit for the American Board of Psychiatry and Neurology (ABPN) Examination in CNP. A second year of fellowship is encouraged as an ACGME accredited epilepsy fellowship, with emphasis on clinical epilepsy, including video-EEG monitoring, pre-surgical evaluation, intracranial EEG recording, cortical stimulation, device management, and sophisticated management of complicated epilepsy. Successful completion of the epilepsy fellowship allows fellows to sit for the ABPN Examination in Epilepsy.

Structured Rotations: CNP Fellows follow rotations through the EEG laboratory, epilepsy monitoring unit (EMU), and the EMG lab.  Epilepsy fellows follow rotations through the EEG laboratory, EMU, and 2 months of morning electives in neuropsychology, neuroradiology, neuropathology, neurosurgery or research. A typical yearly schedule for each fellowship is listed below:

 Clinical NeurophysiologyEpilepsy
EEG Lab6 months4 months
EMU4 months6 months
EMG2 months0 months
Elective0 months2 months


Clinic:
Each CNP fellow typically has 1 half-day of epilepsy continuity clinic per week. Epilepsy fellows typically have 2 half-day continuity clinics per week but frequently attend other clinics including epilepsy diet clinic, pediatric epilepsy clinic and Tuberous Sclerosis clinic. The Epilepsy Clinic has approximately 5000 visits per year.  Patients maintain continuity with specific fellows so fellows can learn from longitudinal delivery of care. In addition, fellows see patients in the Clinical Trials Clinic one clinic per week during EEG lab rotations. Fellows also participate in 2-day field clinics in rural Appalachia 3 or 4 times per year. The field clinics are unique because they have been maintained since the 1950s and have a significant concentration of unusual pathology and give fellows more independence.

EMU: State of the art EMUs are located in the University of Virginia Hospital. A primarily adult 8 bed EMU is located on the 6th floor near general neurology and admits 300 patients per year. A pediatric 6 bed EMU is located on the 7th floor near general pediatrics and admits 150 children per year. The main EMU inpatient team consists of an epilepsy attending, one or two fellows and a resident. Fellows assigned to this rotation review EEGs for both EMU services as well as off-service floor continuous EEGs and attend rounds with the adult EMU team.

ICU: There is a dedicated ICU EEG service that interprets video-EEG from patients monitored in a variety of ICU settings inclusive of both adult and pediatric studies. There are approximately 1200 continuous ICU EEG studies performed each year.

EEG Lab: The EEG lab is located in the University Hospital and annually performs approximately 3000 routine EEGs, and 150 evoked potentials. Studies are read by fellows as the studies are performed and then reviewed with an attending physician in the afternoon.

Epilepsy Surgery: The epilepsy surgery program includes all types of evaluation including intracranial depth, strip, and grid electrodes, intraoperative and extraoperative cortical mapping. Surgeries routinely performed include VNS and RNS implantation, laser ablation, as well as resective surgery. Language and memory testing during intracarotid amobarbital (Wada) testing is performed by fellows supervised by the EEG attending. Approximately 15 surgeries are performed per year, with many patients receiving intracranial electrodes.  Epilepsy fellows are responsible for presenting patients at weekly Epilepsy Surgery Conference.

Didactic Training:  Conferences are generally scheduled at noon each day: Monday for Epilepsy Conference, Tuesday for EEG Resident’s conference, Thursday for Fellows Reading Conference, and Friday for Grand Rounds and monthly journal clubs. Epilepsy Surgery and Epilepsy Neuropathology Conference is held each Thursday morning. Fellows take the annual American Clinical Neurophysiology Society EEG in-service examination.

Call: Fellows take calls in half-week blocks. Weekend call is equally distributed among the fellows each year and is typically every fourth to fifth weekend. While on call fellows respond to requests for EEGs during the evenings and weekends. Fellows decide which EEGs are to be performed and notify the on-call EEG tech of the request. Nighttime calls are usually infrequent since EEG techs are not available from midnight to 6:00 a.m.

Research: Fellows participate in ongoing clinical research studies and in an individually-mentored hypothesis driven research project. There is involvement in the clinical research program in the investigation of experimental therapeutics, such as antiepileptic drugs, devices, and novel surgical approaches; typically 3 new drugs and 2 new devices are under investigation.

Faculty: A list of services and faculty can be found at: https://uvahealth.com/services/epilepsy