Epilepsy and Clinical Neurophysiology
The Maryland Comprehensive Epilepsy Center offers two ACGME accredited fellowships: Clinical Neurophysiology/EEG and Epilepsy. The program has a long tradition of teaching excellence and we are proud to continue to provide training for future neurophysiologists and epileptologists that go on to serve in private or academic roles in our region and nation. We have an exciting team that includes excellent educators, clinicians, and researchers.
Overview
Fellows receive training in the evaluation, diagnosis, care, and management of patients with seizures and epilepsy in addition to comorbid or related conditions. Fellows will learn the surgical evaluation and treatment of patients with intractable epilepsy. Pre-surgical evaluation experience will include education in the associated diagnostic tools of imaging in epilepsy, neuropsychological testing, intracranial EEG interpretation and the planning of epilepsy surgery with Neurosurgery. Fellows will learn the indications and management techniques associated with neurostimulation for epilepsy including vagus nerve stimulation (VNS) responsive neurostimulation (RNS) and deep brain stimulation (DBS) therapies. Fellows will have in-depth training on the basic mechanisms of epilepsy, epidemiology, classification, syndromes, imaging, pathology, genetics, EEG and treatment. We have specialty outpatient experiences through the Women's Epilepsy Program, First Seizure Clinic and Neuromodulation Programming Clinics.
The Maryland Comprehensive Epilepsy Center is a tertiary Level IV NAEC accredited epilepsy center which provides care to approximately 2,000 individuals annually with epilepsy, seizures, and related neurological disorders. The outpatient care clinic forms the basis for the initial referrals of patients to the epilepsy center, though patients are often also referred for inpatient epilepsy monitoring by outside physicians and hospitals. It is one of only two major Level IV centers in Maryland providing comprehensive care to people with epilepsy and support to their families. A substantial proportion of our patients are senior citizens, poor or underserved in Baltimore City and the state of Maryland.
Mission
To train excellent epileptologists who can deliver superb patient care, pursue academic research, and educate trainees while serving the community of Baltimore, Maryland and the region. This is in alignment with the University of Maryland Medical Center mission of providing health care services for the Baltimore community, the state of Maryland and the nation. In partnership with the University of Maryland School of Medicine we are committed to delivering superior health care, training the next generation of health professionals and discovering ways to improve health outcomes worldwide.
Aims
Our overall goal is to produce excellent clinical and academic epileptologists with an emphasis on developing more academic specialists in the fields of epilepsy with local and national recognition. We strive to provide advanced training in technique and interpretation of electroencephalograms (EEGs), as well as in all aspects of clinical epilepsy care. We aim to help our trainees develop the skills, expertise and knowledge to practice comprehensive, compassionate, inclusive and excellent clinical care for patients with epilepsy in academic centers or private independent practice. We aim to train fellows with competency performing and interpreting simple and complex EEG studies. We aim for excellence in teaching and hold our faculty to the highest standards. We aim for fellows to participate in scholarly activities that will lead to presentations at national meetings and publications in peer reviewed literature.
Educational structure
Rotations:
Epilepsy Fellows
There are five longitudinal experiences during the year of epilepsy fellowship training.
- Adult and pediatric Continuous or Long-term monitoring EEG (4 months)
- Epilepsy Monitoring Unit and routine EEG rotation (4 months)
- Outpatient continuity clinic and Research (2 months)
- Pediatric Epilepsy (1 month)
- Elective (1 month)
Clinical neurophysiology/EEG- with EMG/NCS
There are three longitudinal experiences during the year of epilepsy fellowship training.
- Adult and Pediatric Continuous or Long-term monitoring EEG (4 months)
- Epilepsy Monitoring Unit and routine EEG rotation (4 months)
- Outpatient continuity clinic, Neuromuscular EMG/NCS and Research (4 months)
-
Adult and Pediatric Continuous EEG (cEEG)
This rotation takes place in the University of Maryland Hospital EEG Review Room in the 12th floor South EEG and Clinical Neurophysiology Lab. The fellow has an assigned work area and a dedicated computer. In the morning, the fellow will review, draft a report, and present each continuous EEG case to the attending physician. We have 15 new Natus EEG machines used to monitor adult and pediatric patients in all areas of the hospital.
In the afternoon, the fellow will review all the cEEG records and will discuss updates with the attending faculty prior to sign-out. -
Epilepsy Monitoring Unit (EMU) and Routine EEG
This rotation takes place in the University of Maryland Medical Center. The Downtown Campus (DTC) EMU is a 4-bed unit located on the 4th floor Gudelsky Building. A second off-site 2-bed unit is located at University of Maryland Rehabilitation and Orthopedic Institute (UM Rehab). In the morning, the fellow will see the patients located at the DTC and discuss care with the neurology resident assigned to the patients. The Fellow will then review all the EMU EEGs and draft a report. The attending physician will be present and available in the EEG review room during the morning. The fellow also will review EEG monitoring of any patients located at the 2-bed UM Rehab EMU.
In the afternoon, the fellow will review routine EEGs, SSEPs and ambulatory EEGs, draft a report and present each case to the attending physician. Reports are subsequently reviewed and edited by the attending physician. -
Outpatient Rotations and Research
The fellow is expected to participate in outpatient epilepsy clinics with an Epilepsy Faculty Practice located on the 3rd floor of the Frenkil Building (16 S. Eutaw Street) 3-4 half days per week. Fellows see patients independently and document patient history and examination by drafting clinic notes in Epic for faculty editing. There are opportunities to see patients in several subspecialty epilepsy clinics including the Women's Epilepsy Program, First Seizure Clinic, Neuromodulation Programming Clinic and the Tuberous Sclerosis Complex program through the only adult-focused TSC center in the region. When not seeing patients on this rotation, fellows are expected to work on their mentored research and QI projects. -
Pediatric Epilepsy (as of 2022, rotation at Johns Hopkins)
The fellows will arrive each morning at Johns Hopkins Children's Center and meet with their assigned attending/co-fellow. Rotations may include reading routine, continuous or EMU EEGs and seeing patients in the pediatric EMU or attending pediatric epilepsy clinics. Fellows will be responsible for pre-reading some EEGs, reading EEG with the attending, and helping on the EMU service with such tasks as admitting and discharging patients and making decisions about their epilepsy care. They will also work with the pediatric epilepsy attendings in outpatient clinics. Fellows will attend the weekly epilepsy conference and other relevant conferences throughout the week (ex. neonatal neurology conference, epilepsy fellows lecture series etc.) -
Elective Rotations
The Epilepsy fellow will have one month dedicated to elective topics related to epilepsy, based on the fellow's preference and interest.
Neuroimaging Elective
The fellow is expected to participate in neuroradiology reading a UMMC with attending on Monday to Friday. They will plan on daily reading time with the neuroradiologist. The fellows will be expected to prepare and present at least one Epilepsy surgical case with the radiological findings during conference held on Monday mornings.
Conference Schedule (as of 2022)
| Monday | 11:30 AM-12:30 PM: Monthly M and M** |
2-3 pm: Epilepsy Surgery Conference |
|---|---|---|
| Tuesday |
11:30 AM -12:30 PM: |
|
| Wednesday |
2-3pm: Case conference ** |
|
| Thursday | 11:30-12:30pm: Epilepsy curriculum lecture & quarterly Journal clubs* QI project and research conferences* |
|
| Friday |
12-1pm:
|
3-4pm: |
All conferences are mandatory.
* Fellow is the main presenter along with epilepsy faculty supervisor and all epilepsy faculty is expected to attend.
** Each fellow presents once a year with faculty supervision and all epilepsy faculty is expected to attend.
The program will provide a comprehensive curriculum in which the latest knowledge and research will be presented and discussed. Journal Clubs will be prepared to teach and discuss up to date evidence-based medicine, research methodology, epidemiology, statistics, peer review, clinical practice, patient care and education. The fellows have protected time to attend/participate in all the conferences. The entire epilepsy faculty is expected nd given time to participate in all the fellow conferences.
The faculty aims to instill the fellows with a critical mindset by discussing and probing the latest medical data during rounds with the hope it creates an everlasting curiosity in research and motivation to advance the field.
Diversity, Equity and Inclusion
The Epilepsy program is presently aware of the value of diversity and inclusion. We also recognize and condemn the effects of structural racism along with its deleterious effects on health equity. In the fellowship we encourage diversity and inclusivity at all levels, we give implicit bias training, encourage transparency in recruitment, teach about the impact of diversity and its influence on health disparities.
For any additional questions and application, please contact:
Epilepsy Fellowship Program Director
Camilo Gutierrez, MD
Associate Professor of Neurology
camilogutierrez@som.umaryland.edu
410-328-6266