NeuroLogic: Epilepsy Rotation
Epilepsy Rotation
What to learn, and in what order, for residents and fellows in any program.
Before your first day
Ask your coordinator for these early. Your institution’s tab has the local list, with names and numbers.
- Health record access, including the epilepsy clinics and the EEG report templates
- EEG review software on the reading stations, such as Natus NeuroWorks and Persyst
- Remote reading through a virtual private network or remote desktop, if your program reads from home
- Paging, secure chat and the call schedule
- Which report template goes with each study type, and who signs the report
- Who to call when a reading station or the EEG software fails
- Where the EEG lab is, its hours, and when you can watch a hookup
New to the reading software? Natus & Persyst walks through opening a study, montages, filters and Persyst trends.
When to communicate
Always tell the supervising attending or fellow when:
- Patient is admitted to the Epilepsy Monitoring Unit (EMU)
- Patient is admitted to the Neuroscience ICU
- Patient is undergoing epilepsy surgery
- There is a significant change or worsening of clinical status
Educational goals
Patient Care & Procedural Skills
Trainees are expected to demonstrate competence in:
- Diagnostic evaluation, medical management, and surgical evaluation of epilepsy patients
- Interviewing and examining patients with epilepsy and seizures
- Differential diagnosis of various clinical presentations
- Appropriate medical/surgical investigations (lab, pathologic, radiologic, neurophysiologic)
- Inpatient and outpatient management (medical and surgical)
- Working in multidisciplinary teams
Medical Knowledge
Trainees are expected to demonstrate competence in knowledge of:
- Basic science, genetics, and epidemiology of epilepsy
- Neuroimaging and diagnostic modalities
- Neuropsychology
- Pharmacologic and non-pharmacologic treatments
- Comorbidities in epilepsy
- Ictal/interictal EEG patterns and prognosis
Other Competencies
- Practice-based Learning: Analyze practice using quality improvement methods; assimilate evidence from scientific studies.
- Interpersonal Skills: effective exchange of information with patients, families, and professionals.
- Professionalism: Commitment to professional responsibilities and ethical principles.
- Systems-based Practice: Awareness of the larger health care system and resource utilization.
Reading list
Essential Textbooks
- Rowan’s Primer of EEG, 3rd Ed (Marcuse, Fields, Yoo); its chapter questions are Rowan’s questions in the Question Bank
- Niedermeyer's Electroencephalography (Schomer & Lopes da Silva)
- Wyllie's Treatment of Epilepsy (Wyllie)
- Handbook of ICU EEG Monitoring (LaRoche)
Key Guidelines & Sites
Residents: Study path
The site has more than you need in one block. Work through it in this order: each step builds on the one before. Tick a step when it is done; your progress stays in this browser.
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Before your first day
Get into the reading software
Everything after this assumes you can open a study and read it the way the lab does.
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Week 1
Learn to read a normal EEG
Montages, filters and the normal record come first: most early misreads are normal variants and artifacts.
- EEG FundamentalsTake the pre-test in lesson 1, then lessons 7–35: the 10–20 system and montages, filters, the normal background and sleep, normal variants and artifacts.
- EEG VideosLessons 1–7 (Introduction to EEG through Normal Sleep) alongside, one or two a day, each with a three-question check.
- Rowan’s questionsChapters 1 and 2 at the end of the week, with the access code from your educator.
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Week 2
Abnormal EEG and the ICU
Spikes, slowing and the critical care patterns you will describe on continuous EEG.
- EEG FundamentalsLessons 36–42: interictal discharges, continuity, the ictal–interictal continuum and seizures.
- EEG VideosLessons 8–10: interictal abnormalities, focal slowing, diffuse slowing and periodic discharges.
- ACNS TerminologyName a Pattern, then Read the Strip, until LPDs, GPDs, LRDA and their modifiers come without looking.
- Rowan’s questionsChapters 4, 5 and 7.
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On every consult
Manage the patient and name the diagnosis
Keep these open on the consult service: they answer the questions asked on rounds.
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Last days
Check what stuck, and where to go next
Measure where you ended up before the block closes, then pick what to keep going with.
- EEG FundamentalsLesson 43, the structured report, and the post-test.
- Rowan’s questionsChapters 3, 6, 8 and 9, then Review Missed/Flagged.
- Board ReviewNotes, cases and free board-style questions, for anyone heading to an epilepsy or neurophysiology fellowship.
- Epilepsy Brain AtlasWhere SEEG leads sit, for EMU patients with intracranial electrodes.
- Learning ResourcesBooks and outside courses to carry on with.
Milestones
Fellows: Study path
The year in the order the tools are needed, following the course schedule below. Tick a step when it is done; your progress stays in this browser.
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July, before your first day on the monitoring unit
Set up, and learn the lab’s report style
Access, software and the report format before you sign a read.
- Before your first dayHealth record, EEG software, remote reading and paging; your institution’s tab has the local list.
- Natus & PersystNeuroWorks setup, then Persyst trends, with the trend lab to practice reading them.
- The structured reportLesson 43 of EEG Fundamentals takes a tracing to a finished report; your institution’s tab has the local templates.
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July–August
Close the gaps in the basics
Matches July in the course schedule: report writing, montages and polarity, and the normal and abnormal EEG. To do it all at once, follow the two-week bootcamp below.
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August–October
ICU EEG and status epilepticus
Intensive care reads start early; this follows August and September in the course schedule: status epilepticus, the ictal–interictal continuum and antiseizure medications.
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Every week, all year
Keep a steady rhythm
Small, regular doses beat a spring cram.
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By block
Use the tool that fits the rotation
Each block leans on a different part of the site.
- Epilepsy Brain AtlasMonitoring unit and surgery conference: stereo EEG lead naming and 3D placements.
- Board Review, part 8Monitoring unit and surgery conference: surgery, stereo EEG and devices.
- ILAE syndrome lookupPediatric rotation: the 2022 syndromes with their EEG.
- Board Review, part 6Pediatric rotation: syndromes, genetics and causes.
- Seizure Management: women’s healthClinic: pregnancy, contraception and counseling.
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Spring
Board preparation
The ABPN epilepsy examination covers all nine parts.
Fellows: Two-week bootcamp
An optional start for new fellows: every EEG Fundamentals lesson and every Board Review section in ten working days, about an hour of reading and 20 to 30 minutes of questions a day. Each Board Review section ends with its own short checks. Tick a day when it is done; your progress stays in this browser.
Week 1: Reading the EEG
All 43 EEG Fundamentals lessons, with Board Review parts 1 to 3 beside them.
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Day 1 · about 1 hour
The signal and where it comes from
Take the pre-test first, then follow cortical currents to the scalp and see how seizures start and stop.
EEG Fundamentals
Lessons 1–6- Welcome and the pre-test
- Signal physiology: summation, ion flow and dipoles
QuestionsPart 1 questions
OptionalVideo: Introduction to EEG
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Day 2 · about 1 hour
Montages, filters and recording
Localize with bipolar and referential montages, place the electrodes yourself, and know what each setting does to the tracing.
EEG Fundamentals
Lessons 7–18- The 10–20 map and the placement lab
- Bipolar, referential and four-montage practice
- Filters, troubleshooting and digital recording
Board Review
QuestionsPart 1 questions
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Day 3 · about 1 hour
The normal EEG, awake, asleep and growing up
Describe a background in standard terms, count the posterior rhythm, stage sleep, and read a child against their age.
EEG Fundamentals
Lessons 19–28- Frequency, amplitude and the description language
- The posterior rhythm, reactivity and the adult background
- Maturation and sleep architecture
QuestionsPart 2 questions
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Day 4 · about 1 hour
Variants, artifacts, activation and interictal discharges
Leave normal variants and artifacts alone, and call a discharge only when it meets the criteria.
EEG Fundamentals
Lessons 29–36- Normal variants
- Ocular artifacts, the artifact gallery and Artifact Hunter
- Activation procedures and interictal discharges
QuestionsPart 2 questions
OptionalVideo: Eye movementsVideo: Technical issuesVideo: Interictal abnormalities
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Day 5 · about 1 hour
Seizures, critical care patterns and the report
Recognize evolution, name ICU patterns in ACNS terms and write the report. The Fundamentals post-test closes the course.
EEG Fundamentals
Lessons 37–43- Continuity, the ictal–interictal continuum and periodic patterns
- Seizure onset and evolution
- From tracing to report, then the post-test
QuestionsPart 3 questions
OptionalVideo: Focal slowingVideo: Diffuse slowing and periodic discharges
Week 2: Epilepsy
Board Review parts 4 to 9, with the site’s tools for each topic.
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Day 6 · about 1 hour
Critical care EEG and status epilepticus
The ICU reads start early: name patterns, apply the seizure and continuum criteria, use the trends, and treat status on time.
Board Review
QuestionsPart 4 questions
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Day 7 · about 1 hour
Diagnosis, classification and the first seizure
Was it a seizure, was it provoked, is it epilepsy and what kind; then what to tell the patient about driving and safety.
Board Review
Try it on the site
QuestionsPart 5 questions
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Day 8 · about 1 hour
Syndromes, genetics and causes
The 2022 syndromes by age at onset, the genes that change treatment, and the structural, immune and metabolic causes.
Board Review
Try it on the site
QuestionsPart 6 questions
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Day 9 · about 1 hour
Medical treatment and living with epilepsy
Choose, dose and stop ASMs, treat women and other special groups, and counsel on SUDEP, mood and cognition.
Board Review
- 7.1 Starting, choosing and stopping
- 7.2 How ASMs are handled by the body
- 7.3 ASM profiles and choosing for a patient
- 7.4 Serious adverse effects and pharmacogenomics
- 7.5 Women with epilepsy
- 7.6 Older adults and other special groups
- 7.8 Dietary therapy and other treatments
- 9.1 SUDEP and mortality
- 9.2 Mood, behavior and cognition
Try it on the site
QuestionsPart 7 questionsPart 9 questions
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Day 10 · about 1 hour
Surgery and devices
Who to refer and when, what each test adds, how intracranial EEG is read, and what resection, ablation and neuromodulation offer.
Board Review
Try it on the site
QuestionsPart 8 questions
After the bootcamp, keep the habit: flashcards most days and one part of fellowship-level questions a week, as in the study path above.
Fellows: Course schedule
An optional year of topics, a few each month from July to June. Programs teach in their own order; if yours has no set curriculum, this gives the year a shape. Each month lists where to study it on this site, and the study path above follows the same months.
- JulReport writing, montages and polarity, the normal and abnormal EEG, quantitative EEGTwo-week bootcampWrite the Report4.5 Quantitative EEG trendsPersyst trend lab
- AugStatus epilepticus, semiology, the ictal–interictal continuum, surgery and intracranial EEG7.7 Status epilepticusStatus epilepticus protocol5.5 Semiology4.2 The ictal–interictal continuum8.3 Intracranial EEG
- SepAntiseizure medications, vagus nerve stimulation, neonatal and infantile epilepsy7.3 Antiseizure medication profilesMedication lookup8.5 Neuromodulation6.2 Neonatal and infantile onset
- OctWorking in the neurocritical care unit, pediatric EEG, responsive neurostimulation, automated seizure detection, developmental and epileptic encephalopathiesBoard Review, part 42.4 From preterm to adolescence8.5 NeuromodulationILAE syndrome lookup
- NovCritical care EEG terminology, women’s health, genetics4.1 ACNS 2021 terminologyName a Pattern7.5 Women with epilepsy6.5 Genetic testing
- DecThe first seizure, when to give antiseizure medication as prophylaxis5.4 The first seizure7.1 Starting, choosing and stopping6.7 Structural causes
- JanManaging the ictal–interictal continuum, neuroradiology, sudden unexpected death in epilepsy4.2 The ictal–interictal continuumRead the Strip8.2 Imaging and functional testing9.1 SUDEP and mortality
- FebSubarachnoid hemorrhage, functional seizures, autoimmune epilepsy4.5 Quantitative EEG trends5.6 Mimics of epilepsy6.8 Immune, infectious and metabolic causes
- MarNew-onset refractory status epilepticus, neuropsychology, health disparities7.7 Status epilepticus9.2 Mood, behavior and cognition
- AprSleep and movement disorders, treating functional seizures, quality of life and driving5.6 Mimics of epilepsy9.3 Driving, safety, work and school
- MayNeonatal status epilepticus, magnetoencephalography and source localization3.4 Neonatal seizures8.2 Imaging and functional testing
- JunHypoxic–ischemic encephalopathy and prognosis3.4 Neonatal seizures2.4 From preterm to adolescence4.3 Coma, cardiac arrest and prognosis
Mount Sinai survival guide
Where to be each day on the monitoring unit, in clinic and on the pediatric and intensive care unit blocks; the team and its extensions; the Epic report templates; call and sign-out; transfers; and the New York, New Jersey and Connecticut driving rules.
Once it opens, this browser stays signed in for 30 days.