MGH Epilepsy/Clinical Neurophysiology Fellowship Program

The intent of this two year fellowship is to provide a strong foundation in clinical epileptology and in the technical, interpretive and clinical aspects of electroencephalography and evoked potentials such that the fellow would be able to direct an Epilepsy Program and an EEG/EP laboratory. Our fellowship program offers training to adult and pediatric neurologists. The Fellowship Program relies on case based learning to achieve its educational objectives. Clinical experience is complemented by a series of didactic lectures, an array of clinical and scientific weekly conferences, and a journal club. Fellows also gain teaching experience in their interactions with Neurology residents, medical students, and allied health professionals.

The first year of fellowship is a fully accredited Clinical Neurophysiology Training Program (The MGH Clinical Neurophysiology Training Program) that qualifies participants to take the American Board of Psychiatry and Neurology Added Certificate in Clinical Neurophysiology examination.

Application instructions can be found below.

A detailed statement of Goals and Objectives, including the MGH Epilepsy/EEG Clinical Neurophysiology Fellowship Curicculum Document describes the goals of the fellowship as presented to the ACGME.

Download Clinical Neurophysiology Training Program description

Download 2nd Year Epilepsy Fellowship description

Epilepsy Service

The Epilepsy Service at the Massachusetts General Hospital is staffed by Drs. Andrew Cole, Daniel Hoch,  Elizabeth Thiele, John Stakes, Stephen Parker, Syd Cash, Ronald Thibert, Brandon Westover, Eric Rosenthal, Catherine Chu, Lidia Moura, Jay Pathmanathan and Ken Sassower. The Epilepsy Service is part of the Division of Clinical Neurophysiology, which also includes the EEG lab, the LTM Service, the EMU, the MGH Sleep Medicine Program and the MGH Sleep Lab, and the Intraoperative Monitoring Service. Additional faculty members include Drs. Matt Bianchi, John Winkleman, James Mojica, Bernard Kinane (all in the Sleep Program), Mirela Simon and Dinesh Nair (both in the IOM Service).

The service includes an inpatient consultation service, an active outpatient epilepsy clinic, an epilepsy monitoring unit, an epilepsy surgery program co-directed by Dr. Emad Eskandar, a Pediatric Epilepsy Program directed by Dr. Thiele, and an active epilepsy research program including both clinical and basic science research approaches to the problem of chronic epilepsy. In addition to offering advice on the medical management of seizure disorders, and evaluation for the surgical management of such problems, the Epilepsy Service also provides the opportunity for patients to enroll in investigational treatment protocols.

The fellow’s time will be divided between the Clinical Epilepsy Service, the EEG/EP Laboratory, the Epiloepsy Monitoring Unit and the Long Term Monitoring Service. On the Epilepsy Service, the fellow will be responsible for:

1. Performing inpatient consultations on patients with epilepsy or related problems under the supervision of a staff epileptologist
2. Supervising the evaluation of inpatients admitted to the Epilepsy Monitoring Unit in conjunction with staff physicians and the neurology resident staff
3. Attending Adult or Pediatric Epilepsy Clinic once per week (depending on the Fellow’s primary interest) and First Seizure Clinic as required, and Pediatric Epilepsy Clinic (for Adult Epilepsy Fellows) or Adult Epilepsy Clinic (for Pediatric Epilepsy Fellows) as desired
4. Performing electrocorticography under the supervision of a clinical neurophysiologist
5. Supervising intracarotid amobarbital (Wada) testing
6. Assisting in the didactic and interactive teaching of neurology house staff with regard to epilepsy
7. Participating in clinical or basic research protocols involving patients on the Epilepsy Service
8. Organizing the weekly Surgical/Medical Epilepsy Conference.

The MGH Epilepsy Monitoring Unit is equipped with a state-of-the-art fully networked Xltek digital video-EEG system. Five adult beds, four pediatric bed, and several portable unit are used for data acquisition. All studies can be reviewed on-line on dedicated review stations located throughout the clinical neurophysiology laboratory, the neurology clinic, and the Epilepsy Service office suite. Monitoring studies include pre-surgical localization studies using extracranial electrodes (70%), intracranial electrodes (10%), and diagnostic studies (20%) in both adults (75%) and children (25%). (All percentages are approximate.)

The MGH Long Term Monitoring Service is equipped with 8 portable video-EEG machines. In addition, the MGH Neurology ICU is hard wired with videoEEG acquisition systems in all 22 patient rooms. The LTM Service currently performs up to 10 studies per day to evaluate coma, status epilepticus, altered mental status, sub-arachnoid hemorrhage, and traumatic brain injury. Approximately 20% of LTM studies are performed on pediatric patients, mainly in the pediatric and neonatal ICU settings.

Clinical and Laboratory Research

Extensive clinical and laboratory facilities are available to support the research efforts of the Epilepsy Service.  Current research projects include:

1. Studies of investigational anti-epileptic drugs and devices for epilepsy
2. Genetic studies in epilepsy
3. Studies of functional imaging techniques including 15O PET and functional echo-planar MRI imaging with intraoperative correlation
4. Magnetic resonance spectroscopy studies of patients with focal and generalized epilepsy
5. Neuropathological studies of developmental abnormalities in pediatric epilepsy
6. Studies of magnetoencephalography and its application in diagnosis of focal and generalized epilepsies,
7. Studies of language organization in the presence of structural and anatomic lesions using fMRI
8. Anatomic and biochemical studies in human surgical material and in animal models of chronic epilepsy (In the Epilepsy Research Laboratory directed by Dr. Cole)
9. Multimodal microphysiology studies of human cortex using laminar electrodes and high-density microelectrode arrays implanted in patients undergoing pre-surgical investigation (Under the direction of Dr. Cash).
10. Health Services studies in Epilepsy
11. Natural history studies in epilepsy

Clinical Neurophysiology Laboratory

Approximately 30% of the fellow’s time will be devoted to the Clinical Neurophysiology Laboratory directed by Dr. Andrew Cole where the fellow will be responsible for:

1. Assisting the technologists with all problems arising in the EEG/EP laboratory and intensive monitoring units relating to the acquisition of reliable data from patients
2. Assisting the first year neurology resident rotators (6 weeks) in learning basic EEG/EP interpretations and clinical correlations
3. Providing preliminary interpretations of all routine EEG/EPs done in the EEG laboratory each day and reviewing these the following morning with the staff neurophysiologist
4. Assembling EEG/EP, clinical and radiographic materials for two weekly conferences, one to review test results on their patients with the ward team, the other to discuss interesting or problematic tests performed in the laboratory during the previous week
5. Giving occasional lectures to the technologists. In addition, the fellow may pursue a clinical neurophysiology research project that can be completed during the course of the fellowship.

The Clinical Neurophysiology Laboratory has 5 EEG and 2 EP recording rooms as well as 6 portable EEG machines and performs about 3500 routine adult and pediatric (including premature) EEGs, ambulatory EEGs, and 300 pattern VEPs, brainstem auditory EPs, and upper and lower limb SEPs per year, primarily for evaluation of neurologic problems. EEG equipment is state-of-the-art digital Xltek equipment and is networked with the monitoring equipment described above. The sleep laboratory uses the same rooms in the evening.  An EMG laboratory is contiguous to the EEG laboratory.  Patient investigations are coordinated between these units when appropriate.

Clinical Neurophysiology Research

There are extensive computer facilities available for EEG/EP work. Current research projects include:

1. Pathophysiology of epileptic phenomena in humans as revealed by MR spectroscopy and fMRI and simultaneous EEG:
2. Studies of the utility of continuous EEG monitoring in various hospital settings:
3. Signal analysis approaches to increasing the sensitivity, specificity and efficiency of continuous EEG data review:
4. Dipole source analysis of benign and abnormal epileptiform transients in normal subjects and patients with epilepsy:
5. EPs in CNS diseases – generator sources as revealed by human clinico-pathologic correlations – pathophysiology of diseases as revealed by EPs – diagnostic and therapeutic implications of EPs
6. Central motor conduction with transcranial magnetic stimulation – studies in normal subjects and patients with neurologic diseases.

Accreditation

The MGH Epilepsy/Clinical Neurophysiology Fellowship is ACGME accredited (MGH Clinical Neurophysiology Training Program). At this time accreditation is offered by the ACGME for one year of fellowship, and fellows are expected to gain exposure to a variety of neurophysiological disciplines. Arrangements can be tailored to meet individual objectives. To meet accreditation requirements, 20% of your time during the first year must be spent in a “non-major” discipline. Epilepsy/Clinical Neurophysiology fellows at MGH currently spend that time in the Sleep lab. The 20% commitment may be satisfied by a combination of didactic and clinical experience. Intraoperative Monitoring experience is also available under the direction of Dr. Simon, but is not currently accepted by the ACGME as satisfaction of the 20% requirement.

Duration

It is expected that most fellows will stay for a two to three year period. While the curriculum is mixed throughout the fellowship experience, the first year will emphasize clinical neurophysiology while the second year will emphasize clinical epileptology and research. Fellows will be encouraged to seek outside sources of funding for the second and third years when appropriate.  The third year of fellowship may be devoted mainly to basic or clinical investigation with limited clinical responsibilities.