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Epilepsy Education
For Neurology Residents
Overview
The residents in the Neurology Residency Program at Yale New Haven Hospital and Yale University School of Medicine rotate regularly through the Epilepsy Program and gain training and experience in inpatient and outpatient aspects of epilepsy, diagnosis, evaluation and treatment. In this role, they spend most of their daily time in the company of the Epilepsy Fellows and/or Attendings where they join in on inpatient rounds, review video EEG recordings utilizing multiple types of electrodes. They evaluate, admit and present patients to the Attending and Fellow and the rest of the team and discuss diagnostic impressions and approaches. Similarly, they examine outpatients and take patient histories in the epilepsy clinics. In these settings, they learn about the international classification of epilepsies and seizures, the older and newer antiepileptic drugs, the diagnostic modalities used to assess type of epilepsy and their interpretations, appropriate treatment, and possible surgery. The responsibility of Neurology Residents, as distinguished from Epilepsy Fellows in these settings, is more limited. They are not required to prepare detailed EEG monitoring reports, nor are they required to present patients at epilepsy conferences for patient review, evaluation and planning of interventional approaches. Nevertheless, they are involved in every aspect of inpatient and outpatient diagnosis and care and ultimately achieve a deep and broad understanding of epilepsy and the multiple facets, consequences, diagnostic approaches and treatments. The residents also have the opportunity to observe a variety of ongoing clinical trials involving epilepsy, predominantly of treatment with newer antiepileptic drugs and newer surgical (stimulation) approaches.
Why do Training in Epilepsy as a Resident
The question of why does additional training in residency pertaining specifically to epilepsy may be raised. There are many reasons for this, even independent of exposure to and possible future academic subspecialty preparation. Epilepsy and its clinical diagnoses and treatment remains one of the major challenges of the general neurologist and changes in the field have accumulated at such a rapid pace that additional training in a specialized program is invaluable for anyone in general neurology practice. Additionally, many of the diagnostic studies including various types of imaging, electrophysiology and neuropsychological evaluation, are pertinent to the diagnostic approaches to many neurologic problems. The expertise gained in the context of an epilepsy setting is well applied to many aspects of general neurology practice. Finally, an understanding of the kinds of specialized diagnostic approaches that are available in epilepsy centers in various locations of the United States and the world, is invaluable to the practicing Neurologist who can refer patients for these types of studies when they understand the utility and the extent of such additional evaluation. Ultimately, the diagnostic acumen required for localization of epilepsy in the context of surgical evaluation is a lesson in cerebral functional cortical anatomy that clearly has application to formulation of all neurologic diagnoses and approaches.
Suggested Reading
Engel J Jr and Pedley TA. (eds) Epilepsy, a comprehensive textbook. Philadelphia, Lippincott-Raven, 1998.
Bleck TP. Refractory status epilepticus. Curr. Opin. Crit Care 2005;11:117-120.
An excellent overview of status treatment and approach to refractory cases.
Gutierrez-Delicado E, Serratosa J. Genetics of the epilepsies. Curr. Opin. Neurol 2004;17:147-153.
A current summary of newly identified genetic epilepsy syndromes.
Hirtz D, Bert AT, Bettis D, et al. Practice parameter: treatment of the child with a first unprovoked seizure. Report of the QSS of the AAN and the Practice Committee of the CNS. Neurology 2003;60:166-175.
This systematic analysis of current data provides insight into studies on
outcome of childhood epilepsy and guidance on treatment.
Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000;342:314-319.
A retrospective review that achieved widespread attention, found intractability
could be established after failure of two monotherapy trials, with very few
responding to combined drug treatment after that.
Nguyen DK, Spencer SS. Recent advances in the treatment of epilepsy. Arch Neurol
2003;60:929-935.
A current review of therapy.
Epilepsy Education at AES
Resident education at AES.
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