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Epilepsy and Clinical Electroencephalography

Neurology 685

Clerkship site: Harborview Medical Center
325 Ninth Avenue
Seattle, WA 98104

Site Director: Wolfgang Muhlhofer, M.D.
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Course description: 

This clerkship experience is housed at the UW Regional Epilepsy Center at Harborview Medical Center. In this clerkship students will learn concepts of seizure workup and treatment in an in- and outpatient setting. This includes the comprehensive workup and treatment of medically refractory epilepsy utilizing various structural and functional imaging techniques as well as formal neuropsychological testing. Further, students will analyze the clinical utility of electroencephalography (EEG) and obtain a working knowledge on basic principles of EEG reading and interpretation.

EEG is an essential diagnostic tool in epilepsy. It is particularly valuable in confirming the diagnosis of epilepsy and classification of seizure types. Simultaneous video-audio recording is the basis for long-term EEG monitoring (LTM). During LTM clinical events or seizures are correlated with electrical activity in the brain to help with differential diagnosis of paroxysmal spells, guide acute patient management and long-term care. Further, LTM (including monitoring with intracranial electrodes) is frequently utilized to guide epilepsy surgery or the implant of neuromodulation devices.

In this clerkship, each student will be under the direct supervision of several faculty epileptologists and work within a multidisciplinary team of fellows, residents, EEG technicians and nurse practitioners on the inpatient LTM ward. Students will also work with faculty at the outpatient epilepsy clinic, attend patient management conferences and lectures facilitated by the UW Regional Epilepsy Center.

For more information please refer to the EEG Rotation Handbook online.

Goals and objectives:

  1. Appraise the clinical utility of EEG-testing for the workup and treatment of seizures.
    • Benchmark: Students will be able to name the clinical indications for EEG, its diagnostic limitations, and how its results are incorporated in the overall clinical decision-making process. 
    • Curriculum: Students will admit and follow at least two LTM-patients a week, writing admission and daily progress notes. Students will discuss their clinical hypothesis and differential diagnosis for various spell types with faculty and fellows at time of admission. Further, they will re-evaluate their working hypothesis considering daily EEG results and come up with a treatment plan during rounds with the LTM care-team. 
  2. Acquire a working knowledge on basic principles of EEG reading and interpretation.
    • Benchmark: Students will demonstrate a systematic approach to reading and interpreting mostly normal and obviously abnormal findings on EEG.
    • Curriculum: Early into the rotation, students will join one of the EEG technologists observing how to apply EEG electrodes and run a standard recording. Every day students will spend reviewing EEGs with fellows and attendings. Following an online-based introduction on EEG acquisition, display, reading and interpretation, students will start to review short EEGs independently and discuss their findings and interpretation with faculty and fellows during EEG rounds. A selection of textbooks including EEG-primer will be available for barrowing.
  3. Develop a basic framework for the routine and comprehensive care for patients with epilepsy and how seizures affect patients’ and caregivers’ every-day life.
    • Benchmark: Students will be able to name different causes and treatments for epilepsy and identify common psychosocial struggles and barriers to care epilepsy patients encounter on a routine basis. 
    • Curriculum: At least one half-day per week students will spend with faculty at the outpatient epilepsy clinic. During that experience, they will shadow faculty and evaluate patients independently as deemed appropriate by precepting faculty. Further, students will participate in weekly patient management conferences, during an interdisciplinary team of epileptologists, neuroradiologists, neuropsychologists and functional neurosurgeons discuss advanced treatment options for patients with medically refractory epilepsy.

Absentee policy: This clerkship can be taken for 2 weeks or 4 weeks. For a 2-week clerkship, you are expected to attend every day. In the event of an urgent situation necessitating an absence, you must discuss this with your preceptor in advance, if possible. For a 4-week clerkship, please see Absentee/Work Hours Policies in menu at left.

Mini-CEX: No requirement.

Patient log: No requirement.

Pocket syllabus: None

Student evaluation: UWSOM Evaluation of Performance

Course evaluations: E*Value

Final exam: No requirement.

Grading policy: The UWSOM Evaluation of Performance will be used for grading.  The 2-week elective is only P/F.  The 4-week elective is eligible for H/HP/P/F.  The evaluation has 13 categories with score range from 1-4.  We will subtract the "insufficient contact or cannot comment" categories and divide by the total number of catagories scored.  For example:  Student 1 has 13 catagories scored [8(4s), 2(3s) and 3(2s)] = 44/13 = 3.38.  Student 2 has 9 catagories scored [7(4s) and 2(3s)] = 34/9 = 3.78.  Scores will translate to:
3.5 - 4  HONORS
3 - 3.49  HP
1.5 - 2.99  PASS
Below 1.49  FAIL

Contact information: See above.