Epilepsy Rotation - EEG Curriculum

Epilepsy Rotation Internal Survival Guide (July 2025)

Educational Goals & Objectives

Patient Care & Procedural Skills

Fellows 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

Fellows 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.

Site-Specific Goals

Site	Focus & Description
Mount Sinai Hospital (MSH)	Includes Kravis Children's Hospital. Focus on long-term EEG monitoring/interpretation for EMU and ICU patients, overall epilepsy care, pediatric epilepsy, and pediatric epilepsy surgery.
Mount Sinai West (MSW)	Focus on adult epilepsy surgery, outpatient/ambulatory EEGs. Training includes intracranial EEGs for adult surgery, cortical mapping, and outpatient care.

When to Communicate

Trainees MUST communicate with the supervising attending or fellow if:

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

Epilepsy Team Contact List

(Refer to the full PDF/document for phone numbers and emails)

EMU Attendings

Leah Blank, MD
Matthew Davitz, MD
Madeline Fields, MD
Gena Ghearing, MD
Kia Gilani, MD
Shu-wei Hsu, MD
Kyusang Lee, MD
Lara Marcuse, MD
Maite La Vega-Talbott, MD
Sonam Verma, MD
James "Jake" Young, MD
Ji Yeoun ("Jenna") Yoo, MD

Support Team

NPs: Dina Bolden (MSW Inpatient), Vincent Palmieri (MSH Outpatient), Soka Yu (MSW Outpatient), Timothy Bell (Kravis Inpatient)
EMU Coordinators: Nadia Gabriel, Toni Kavanaugh (Peds)
Neurosurgeons: Saadi Ghatan, MD, Ted Panov, MD, Peter Morgenstern, MD
Tech Managers: Roxanne Isom (MSW)
Neuropsychologists: Adam Saad, Sloane Sheldon
Neuroradiologist: Brad Delman
Psychiatrist: Pojen Deng
Admin Assistants: Stephanie Cole, Melissa Sebastian, Amanda Perez
Research: Onome Eka, Kevin Van Geem
Social Worker: Ilona Silva Alvarez

Important Internal Extensions

MSH 8W Front Desk	x45558 (212-241-5558)
MSH EMU Monitor Watcher	x45039 (212-241-5039)
MSH NSICU	x42100 (212-241-2100)
NEMAT	x46467 (212-241-6467)
Help Desk	212-241-HELP

Pre-Fellowship Checklist

VPN Access established
Hospital DEA number obtained & linked to VPN
Cognisent app (NotifyMD) set up (Coordinator to email Yvette Lopez)
Natus and Citrix Access (Coordinator to email Pepi Dakov)
EPIC Access to clinics (Call helpdesk 212-241-4357, add EPIC ID 8530012 [HOSP NEURO SEIZURE])
Teams App installed
Imprivata setup
Added to EPIC chat groups

General Resources

Call Schedule: www.amion.com (pwd: msneuro)
Paging: x41300 (212-241-1300) or via Amion
EEG Citrix Access: msvpn.mountsinai.org

IT & Natus Issues

To Open a Ticket for Natus Issues:

Email: `Support.Helpdesk@mountsinai.org` AND `Devell.Perdue@mountsinai.org`
Assignment Group: XLTEK
Include: Problem, Screenshots, Workstation Name/IP (e.g., MSN REV01), Building/Room #, Contact info.
Call: 212-241-HELP (Get a ticket number)

EEG Laboratories

MSH: Annenberg 2nd floor – Neurology Practices Area
MSW: 4th floor
Hours: Mon-Fri 8am – 4pm

Fellows/Residents are encouraged to observe hookups and perform layouts early in training (July/Aug).

Residents: Inpatient Rotation (MSH & MSW EMU)

AM Workflow (~7am - 12pm)

7:00-8:00 AM	Arrive and pre-round on patients (EMU and epilepsy consults).
8:00-9:00 AM	Attend Morning Report.
9:00-10:00 AM	Read at least one LTM EEG (Week 1: EMU study, Week 2: EMU + ICU study) and draft reports. Continue following until monitoring ends.
10:00-12:00 PM	Round with Epilepsy Fellow/Attending.

PM Workflow (12pm - 5pm)

12:00-1:00 PM	Neurology Noon Conference (MSH).
1:00-5:00 PM	Elective admission H&Ps Epilepsy consults (supervised by fellow) Follow-up on LTM EEGs read in AM Read 1-2 new inpatient routine EEGs

Residents: Outpatient Rotation

MSH Amb EEG/Outpatient (PGY-2)

8-9 AM: Morning Report
AM: Epilepsy Clinic OR EEG Reading (review 1 LTM with team).
PM: Resident Continuity Clinic OR Faculty Clinic. Ambulatory EEG reading with attending.

MSW Outpatient (PGY-2)

AM: Epilepsy Clinic (if no clinic, self-study EEG reading).
PM: Ambulatory EEG readings with block attending.
Note: One afternoon is Continuity Clinic.

Clinic Schedule (Sample)

Day	AM (9-1)	PM (1-5)
Mon	Ghearing (MSH)	Resident Clinic / Reading
Tue	Blank (MSH) / Fields (MSW)	Reading / Afternoon Rounds (2-4 PM)
Wed	Yoo (MSH)	MDC Conf (4-5:30) / Didactics
Thu	Ghearing (MSH) / Marcuse (MSW)	Reading / Clinic
Fri	Yoo (MSH)	Didactics

Teaching Rounds

Event	Time	Description
Epilepsy Surgery Conf	Wed 4-5:30 PM	Mandatory. Case presentations & surgical planning.
Teaching Rounds	Wed 1-2 PM	Week 1: ICU EEG Week 2/3: Faculty Lectures Week 4: Journal Club
EEG Conf (Biweekly)	Mon 12:30-1:30	Interesting cases.
Grand Rounds	Fri 8-9 AM	Neurology Grand Rounds.
Resident EEG Conf	Fri 12-1 PM (Biweekly)	Attending/Fellow reviews interesting block cases.

Milestones & Resources

Epilepsy Milestones EEG Index

Fellows: Inpatient Rotation

Locations: MSH 8West (4 beds) & MSW 8B (4 beds).

Daily Routine

Time	Activity
AM (7-8)	Start reading LTM EEGs (Expert tip: start with ICU studies). Prepare prelim reports.
AM (9-10)	Rounding with Attending. Finalize reports, communicate with primary teams (use '2HELPS2B' score).
PM	Read inpatient routines & baseline LTMs done up to 5 PM. (Incomplete note co-signed by attending). Follow up all LTMs. Add Interim Daily EEG Progress Note in EPIC (1-2 lines). Sign out patients needing night monitoring to on-call fellow.

EMU Admissions & Consults

Admissions: Write H&P, place orders. Check elective calendar with Coordinator.
Consults: See consults from NSICU/Gen Neuro. Supervise resident consults. (Weekends: e-consult or brief note).

Outpatient Clinic (During Inpatient Block)

MSH Rotation: Friday PM (Continuity Clinic with Dr. Muxfeldt).
MSW Rotation: Tue PM (Dr. Marcuse), Thu PM (Dr. Fields).

Fellows: Outpatient Rotation

Ambulatory Block

AM: MSH Clinics (Tue: Blank, Thu: Ghearing, Fri: Yoo).
PM: Read outpatient routine & ambulatory EEGs (MSH, MSW, MSM, MSQ). Round with Attending.

Elective Block

Two MSW AM clinics/week (Tue: Marcuse, Fri: Fields).

Clinic Schedule Matrix

	Mon	Tue	Wed	Thu	Fri
AM	Ghearing	Blank / Fields	Yoo / Marcuse	Ghearing	Yoo / Fields
PM	Ghearing	Ghearing / Fields	Marcuse	Ghearing / Fields	Yoo / Marcuse

Fellows: Pediatric Rotation

Focus: Neonatal/early childhood EEG, syndromes, genetics, keto, pre-surgical. (Kravis 5th Floor).

AM (Mon-Fri)	8-11 AM: Read inpatient EEGs (Kravis, NICU, MSW), elective EMUs.
Tue/Thu AM	9 AM: Peds Neuro Clinic. Finish non-EMU reading before 9.
PM (1-5)	Peds Ambulatory Reading. Clinics: Tue PM (Dr. La Vega at MSBI), Fri PM (Dr. La Vega at MSH).

Info for ICU Fellows

1st Year Rotation (1 mo): Read 1 NSICU LTM in AM. Read 1-2 routines in PM. Attend conferences.
Sub-EEG Track (2-3 mo): Read ALL NSICU studies. Same responsibilities as Epilepsy fellows but focused on ICU.

Other Responsibilities

MDC Preparation

Prepare epilepsy surgery cases (~1 new, 1 follow-up). Wed 4-5:30 PM. Review with attending prior. Use `.mdc` smartphrase.

EEG Conferences

Bi-weekly (Mon 12:30): Present 2-3 interesting cases. Include pediatric cases.

EEG Reporting Protocol

Daily Must-Do's

Include brief clinical history.
List daily CNS-medications with doses.
Annotations: Mark at least 3 (Awake, Asleep, Interictal).
Use "Custom" field to mark findings for database/teaching.

Template Types (EPIC Smart Phrases)

2025VEEG	Standard VEEG (w/ prior routine in 6mo)
2025VEEGNEONATAL	Neonate VEEG
2025EMUVEEG	ALL EMU admissions (Kravis, MSH, MSW)
2025BASELINE VEEG	New hookup without prior routine.
2025SAHBASELINE...	Subarachnoid Hemorrhage (Alpha/Delta ratio)
2025INTRACRANIAL...	Intracranial studies (Know electrode locations!)
2025AMBULATORY	Prolonged outpatient studies

Call Schedule & Sign-outs

Weekdays (5PM-8AM): Epilepsy for all MSHS hospitals.
Weekends (Fri 5PM - Mon 8AM): MSH & MSW Inpatients. (Rounding physically at MSW).

Sign-Out Template

              Hi! This is MSW Friday signout.
              There are ### EMU patients and ### LTMs.
              EMU:
              [Last, First] ([Attending]), [Date]. Home meds: ...
              65M with focal epilepsy. No seizures yet. Plan: Wean meds.

              LTM:
              [Last, First]. ASMs: ...
              92M cardiac arrest. EEG: Burst suppression.
              Weekend Notes: Consult patient, monitor for 24h seizure freedom.
            

Transfer & Consult Guidelines

Appropriate Transfers to EMU

Medically stable patients with frequent breakthrough seizures.
Needs urgent med adjustment with monitoring.
Characterization of PNES (medically stable).
EXCLUDE: Acute stroke/sepsis, active suicidal/homicidal ideation, intubated (unless stable SE for weaning).

Appropriate E-Consults

Super-refractory SE (med management depends on EEG).
Simple management (PO to IV conversion) unaddressed by Gen Neuro.
Note: Always communicate directly before placing e-consult.

Driving Laws

State	Reporting	Seizure-Free Period	Notes
New York	No	1 Year*	*Less at DMV discretion. MD statement required.
New Jersey	Yes	6 Months	Physicians MUST report.
Connecticut	No	DMV Discretion	No set period.

NY Commercial: Generally disqualified if diagnosed with seizure disorder.

Lecture Curriculum (2025-2026)

Jul: Report writing, Montages/Polarity, Normal/Abnormal EEG, Quant EEG.
Aug: Status Epilepticus, Semiology, IIC, Surgery/Intracranial.
Sep: ASMs, VNS, Neonatal/Infancy Part 1.
Oct: NSICU expectations, Ped EEG, RNS, AI Detection, DEE.
Nov: Critical Care Terms, Women's Issues, Genetics.
Dec: First seizure, Med prophylaxis.
Jan: IIC Mgmt, Neurorads, SUDEP.
Feb: SAH, PNES, Autoimmune.
Mar: NORSE, Neuropsych, Disparities.
Apr: Sleep/Movement, Functional, QOL/Driving.
May: Neonatal SE, MEG/Source Loc.
Jun: HIE/Prognostication.

NeuroLogic: Epilepsy Rotation