The Epilepsy Fellowship begins with the two months Clinical Neurophysiology Introductory Course that covers all areas of clinical neurophysiology. The anatomy, physiology, pathophysiology, and clinical neurophysiological features of disease are emphasized.

Clinical training

Throughout the Epilepsy Fellowship, you alternate between rotations in the electroencephalography (EEG) laboratory and epilepsy inpatient and outpatient services.

EEG rotations

EEG experience is included in your training. During the time spent in the EEG lab, you interpret a large number of EEG records from adults and children with epilepsy and related disorders. You are given increasingly independent responsibility to oversee complex problems, take emergency call, oversee and perform prolonged EEG and surgical monitoring, teach residents, and present lectures and seminars.

You are exposed to a variety of seizure problems, monitoring techniques used to evaluate patients with seizure disorders (including prolonged monitoring and ambulatory monitoring), and pre-surgical and intraoperative electrocorticography studies.

Epilepsy rotations

During the time spent on the epilepsy service, you care for patients on the inpatient epilepsy monitoring service as well as see patients in the epilepsy outpatient clinic and the hospital epilepsy consulting service. You also are involved in prolonged EEG monitoring in patients admitted to the ICU and gain experience in the planning and interpretation of intracranial EEG recordings in pre-surgical patients.

The schedule of clinical activities is designed to achieve a balance between the outpatient and inpatient settings to ensure that you have experience with different aspects of epilepsy care. You work with both adult and pediatric patients and are involved with drug therapy and surgical treatment for both new-onset seizures and refractory epilepsy.

You also participate in:

• Amytal testing
• Intraoperative monitoring
• Video EEG recordings

The rotations are designed to give you gradually increasing responsibilities in these areas. By the end of your fellowship, you should be able to perform these activities independently.

• EEG lab. In the EEG lab, you interpret a large number of both routine and ambulatory EEG records from adults and children with a wide variety of disorders. Our lab performs more than 4,000 routine EEGs and more than 250 ambulatory EEGs annually, ensuring you will experience a wide variety of clinical scenarios and associated EEG findings.
• Surgical and ICU Monitoring Service (SIMS). On the SIMS service, you perform all monitoring for adult inpatient non-EMU hospital prolonged EEGs, pediatric and neonatal ICU prolonged EEGs, intraoperative EEG monitoring for vascular surgeries, intraoperative electrocorticography, extra- and intraoperative stimulation mapping, and stereoelectroencephalography (SEEG) monitoring performed for surgical epilepsy evaluations. Our SIMS service is responsible for more than 2,500 studies annually.
• Epilepsy monitoring units (EMU).  In the EMU, you monitor patients during evaluations for epilepsy and other types of spells. Both adult and pediatric EMU rotations are included throughout the year. In the EMU you also assess patients with drug-resistant epilepsy for epilepsy surgery, including planning additional studies and, when appropriate, preliminary SEEG planning based on the initial non-invasive evaluation. You present these patient cases at our weekly surgical epilepsy conference. Our EMUs admit more than 900 patients annually.
• Epilepsy clinic. A clinically-grounded education is important in understanding neurophysiology. You see patients in the adult and pediatric epilepsy clinics and maintain a continuity clinic of patients with epilepsy to understand the clinical intersection of EEG and epilepsy. Continuity clinics may be adult or pediatric based on your training background.
• Epilepsy electives. As part of ACGME accreditation, you must have epilepsy-related electives of your choice. Elective options include the following:
  • Research
  • Advanced Post-processing of Epilepsy Imaging and Curry Source Localization
  • Neuropsychology - interpretation of neuropsychometric testing
  • Neuroradiology of Epilepsy
  • Sleep Medicine

Didactic training

In addition to two months of intensive clinical neurophysiology introduction, you attend clinical conferences, lectures, lecture-demonstrations, Journal Club lectures, seminars, and small discussion groups as part of the clinical neurophysiology EEG curriculum.

You also attend other seminars and conferences related to EEG and epilepsy care. 

• sEEG Planning Conference (weekly)
• Epilepsy Surgical Conference (weekly)
• Interesting EEG Conference (every other week)
• Interdisciplinary & Cares Meeting (monthly)
• Epilepsy Division Tri-Site Video Conference (quarterly)
• Outcome Case Presentations (quarterly)  
•  ACNS In-Service Exam Prep Course (January-February) 

You may also attend other weekly seminars and conferences in neurology, neuropathology, and pediatric neurology.

Research training

You are expected to complete at least one investigative project during your training. The type of research project you select depends on personal interests, capabilities, and the time available. Opportunities are available for collaborative studies with other clinical and basic science sections at Mayo Clinic.

You are expected to present completed research at a scientific meeting or prepare it for publication in a scientific journal. This experience teaches how to comprehend and critically evaluate other reported investigations and gain insight into the conduct and principles of research. Mayo covers expenses for travel, hotel, and registration to support the presentation of research performed during fellowship training.

Evaluation

To ensure that you acquire adequate knowledge and develop your technical skills, your performance is monitored carefully during the Epilepsy Fellowship. You are evaluated formally by supervising faculty members after each clinical rotation and meet with the program director to review these evaluations.

In addition, you regularly evaluate the faculty members to ensure that your educational needs are being met.