All of our residents complete 1-2 months of SMU coverage. Much of your time during this rotation is spent on the inpatient epilepsy service, also known as the Penfield Epilepsy service, which includes a seven bed video EEG monitoring unit. Most of the admissions to this service are scheduled ahead of time, so you usually know who is coming in for monitoring and when they will arrive. The most common reasons for admission are:
• Classification of seizure type. Epileptic or non-epileptic? Partial versus generalized?
• Significant medication changes
• Pre-surgical evaluation. Some epilepsy patients may be candidates for surgical treatment. We do the pre-surgical "work-up" here, which may include any combination of the following tests: MRI with 3.0T scanner, MEG scanning, PET or SPECT scanning, epidural/subdural electrode recording, neuropsychological evaluation, and WADA testing.
If a patient is a good surgical candidate, our neurosurgery colleagues do a resection. Over 500 resection surgeries have been performed in the last several years for epilepsy patients.
Each morning you will review excerpts from the 24-hr EEG/video recordings with the fellow and attending to look for ictal and inter-ictal abnormalities. After rounds, the resident is responsible for doing H&Ps and discharge summaries. In the afternoon, the resident interprets the routine EEGs done that day (from everywhere in the UAB system, including outpatient and inpatient) with an attending and a fellow. After two months of epilepsy, you will have reviewed about 100-150 routine EEGs and over 250 24-hour video EEGs.