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CLINICAL NEUROPHYSIOLOGY FELLOWSHIP Neurology

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CLINICAL NEUROPHYSIOLOGY FELLOWSHIP Neurology Powered By Docstoc
					     STANFORD UNIVERSITY MEDICAL CENTER
        CLINICAL NEUROPHYSIOLOGY FELLOWSHIP

                           Epilepsy Center Website
   http://www.stanfordhospital.com/clinicsmedServices/COE/neuro/epilepsy/index.html

Stanford University Medical Center in Stanford, California is offering positions for
clinical neurophysiology/epilepsy fellowships. This fellowship is accredited by the
American Medical Association Commission on Graduate Medical Education, and
prepares the fellow certification for special competence in Clinical Neurophysiology.

Background on Stanford University Medical Center

The Stanford University Medical Center is a premier referral center for patients with
neurological and neurosurgical disorders. The Epilepsy staff consists of four
neurologists, two neurosurgeons, one neuroradiologist, and numerous consulting
physicians. Participating in the program as well are nursing personnel,
neuropsychologists, a psychiatrist specializing in epilepsy, and a variety of medical
specialists. Stanford has a Neurology Residency program with approximately twelve
residents. Stanford is a 575 bed hospital that combines aspects of general and specialty
clinical care, teaching, research and academic medicine. Up to 34 beds are available for
Neurology and Neurosurgery cases. There is a 23 bed intensive care unit and additional
beds for step-down intermediate care. There are three operating rooms available for
performance of neurosurgery. Stanford has available superb neuro-radiology facilities
including CT, MRI, 3-dimensional MRI angiography, functional MRI, SPECT studies
and FDG PET scanning, and investigational imaging technologies. Interventional
neuroradiology for vascular disease is also performed.

Outpatient neurology clinics are active Monday through Friday. Multiple teaching
conferences occur almost every day, spanning the areas of clinical neurology, epilepsy
and EEG, cerebrovascular disease, pediatric neurology, neuropathology,
neuropsychology, neuroradiology, neurosurgical case management, and research issues.

Stanford is known around the world for its research programs, spanning all areas of
medicine. Fellows are encouraged to become involved with Stanford research in the
second year of their fellowship.

The Epilepsy Program:

Clinical Faculty of the Stanford Comprehensive Epilepsy Center include the following:

Robert S. Fisher, M.D., Ph.D.

Dr. Fisher is Maslah Saul MD, Professor of Neurology and Neurological Sciences at
Stanford, and Director of the Stanford Comprehensive Epilepsy Center. Previously, he



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was Chairman of the Department of Neurology, Chief of the Epilepsy Center at Barrow
Neurological Institute in Phoenix, and Newsome Professor of Clinical Neurology at the
University of Arizona. He received his Ph.D. in the neurosciences in 1976, and a M.D. in
1977, from Stanford University. He then took specialty training in internal medicine at
Stanford and in Neurology at Johns Hopkins, where he was co-director of the Epilepsy
Program for eleven years, and a tenured Associate Professor. Dr. Fisher's professional
goal is to derive new treatments for previously untreatable seizure disorders by merging
information from the research laboratory with clinical practice. He is author or co-author
of over 100 peer-reviewed publications in medical journals, and of two books on
epilepsy. He frequently chairs symposia and meetings, speaks at national or international
conferences on subjects related to seizure disorders, has been on review boards for
national grant applications, and currently serves on the editorial board of several epilepsy
and EEG-related journals. He has won research awards from the Klingenstein
Foundation, the Epilepsy Foundation of America and the National Institutes of Health.
His peers named him to be listed 1996-2000 in Best Doctors in America, and he has been
listed as one of the Best Doctors (Neurology) in the Bay area. Dr. Fisher has served as
President of the Epilepsy Society of Arizona; founding chair of the AES Public
Education Committee and of the Research Committee; chair of the EFA Research
Initiative Campaign, EFA Research Grants and Fellowships Committee, and the EFA
Advocacy Committee; EFA Executive committee and as a member of the AES Research
Awards Committee and AES Secretary for three years. He is Past-President of the
national American Epilepsy Society, and Editor-in-Chief of Epilepsia. He is currently
Editor-in-Chief of epilepsy.com, the most visited website on epilepsy in the world.

Donald Olson, M.D.

Dr. Olson, Assistant Professor of Pediatrics and Neurology, completed training in
pediatrics at Children's Hospital of San Francisco, in neurology at the University of
Washington in Seattle, and in epilepsy and EEG at UCLA Medical Center in Los
Angeles. He has served as assistant director of the MINCEP Epilepsy Program for
Children at Gillette Children's Hospital in St. Paul, Minnesota and as director of the
Epilepsy Program and Clinical Neurophysiology Laboratory at Children's Hospital
Oakland. He currently directs the Epilepsy Program for Children at Lucile Salter Packard
Children's Hospital at Stanford. Dr. Olson specializes in seizure disorders of children,
and in EEG and pre-epilepsy surgery studies of children with epilepsy.

Martha Morrell, M.D.

Dr. Morrell, Professor of Neurology, who is internationally renouned for her work on
Women’s issues in epilepsy, is now back at Stanford part-time, with Seizure Clinics.

Kevin Graber, M.D.

Dr. Graber is an Assistant Professor of Neurology. He received his M.D. from Indiana
University School of Medicine in 1992. Following a transitional internship in
Indianapolis, Indiana he completed his Neurology residency at Stanford University from



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1993-1996. He received a fellowship from The Charles A. Dana Foundation in 1996 and
began investigating mechanisms of post-traumatic epileptogenesis as a postdoctoral
fellow studying with David A Prince, MD. During this fellowship he was a recipient of a
National Epifellows Foundation grant, and a Junior Investigator Award for travel to the
American Epilepsy Society’s annual meeting. In 1996, Dr. Graber was appointed to the
clinical faculty of the Department of Neurology and Neurological Sciences at Stanford
University. From 1999-2000 he trained in EEG and clinical epilepsy as a continuing
fellow at Stanford University. He was the recipient of the Mentored Clinician Scientist
Development Award (K08) from the NIH (under the sponsorship of David Prince, MD).
Dr. Graber investigates cellular mechanisms of post-traumatic epileptogenesis, with
emphasis on prevention. He also is a clinician who cares for patients at the Stanford
Comprehensive Epilepsy Center and for the general neurology inpatient service.

Josef Parvizi, M.D., Ph.D.

Dr. Parvizi is an Assistant Professor of Neurology, new to Stanford as of 2007. His
expertise is in behavioral and cognitive issues in epilepsy. Josef trained with Dr. Antonio
Damassio, and he served for 3 years as faculty at the University of Iowa. He received
clinical training at Harvard, Mayo Clinic and UCLA.

David Chen, M.D.

David Chen, MD attended medical school at New York University School of Medicine
where he remained for his internship in internal medicine. He completed his residency in
Neurology at Stanford University in 1998, where he continued his training as a fellow in
epilepsy. He currently is on the neurology staff at Santa Clara Valley Medical Center in
San Jose as an attending, and has begun a subspecialty epilepsy clinic. He continues to
maintain close ties with Stanford for collaboration in the presurgical evaluation of his
epilepsy patients at Valley Medical Center, and continues to see patients at Stanford as
instructor for the Epilepsy Center.

Lawrence M. Shuer, M.D.

Lawrence M. Shuer, M.D. is Associate Professor of Neurosurgery at Stanford University.
He is also the Chief of Staff of Stanford Hospital and Clinics and Associate Dean for
Graduate Medical Affairs at Stanford University School of Medicine. He was previously
the Acting Chair of the Department of Neurosurgery at Stanford University between
March of 1992 and December 1995. He initially joined the faculty in 1984 after
completing residency training in Neurosurgery at Stanford.

Dr. Shuer has had research interests in the effects of hypoglycemia on ischemic central
nervous system tissue. He has been involved in research in regeneration of spinal cord
following surgical injury in the laboratory rat. Dr. Shuer has also aided NASA in the past
with projects in spinal cord neuroanatomical studies as well as intracranial pressure
determinations. He is currently involved in a project looking at new methods of treating




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fungal meningitis in an animal model. He has also investigated the clinical evaluation
and treatment of Chiari malformations with syringomyelia.

Dr. Shuer is currently involved in a multidisciplinary approach to the management of
patients with intractable epilepsy and children with craniofacial malformations. He is
involved in the training of residents, interns and students in the field of neurological
surgery. He also is a very busy clinician, caring for quite a number of patients with
neurosurgical problems.

Jaimie Henderson, M.D.

Jaimie Henderson, Assistant Professor of Neurosurgery, is currently the head of the
Functional Neurosurgery Program at Stanford University. He previously worked at the
Cleveland Clinic. His research interests are: functional neurosurgery of movement
disorders and epilepsy.

John Barry, M.D.

Dr. Barry, Associate Professor of Psychiatry, specializes in psychiatric issues in epilepsy.
His presence on daily rounds and in consultation with most inpatients in the Epilepsy
Monitoring Unit and with many outpatients adds immeasurably to the Epilepsy Program,
where many of the patients have psychiatric or psychological problems. Dr. Barry is
pioneering group therapy treatment for non-epileptic seizures, and is developing better
ways of diagnosing this condition. He is on the National Professional Advisory of the
Epilepsy Foundation, and has published several articles on psychiatry and epilepsy.

Mimi Callanan, RN, MSN

Ms. Callanan has 17 years experience as a Clinical Nurse Specialist in Epilepsy. She has
been in this role at Stanford since the Center opened in 1990. She is a member of the
Professional Advisory Board of the Epilepsy Foundation of America. She is a past
President of the Epilepsy Society of San Francisco and was on the Board of Directors of
the Epilepsy Foundation of Northern California. She is author of several publications
pertaining to education of patients and families about epilepsy, and to the impact of
epilepsy on life.

Bonnie Pamiroyan RN, MSN, FNP

Bonnie Pamiroyan began her nursing career in 1982 after graduating from Baylor
University with a Bachelor of Science in Nursing. After working in a variety of health
care settings, she joined the Stanford Comprehensive Epilepsy Center in 1994 to
coordinate the clinical drug trials provided by the Center. Completing her Master of
Science in Nursing in 2001, her scope of practice has expanded, and she now enjoys
providing extended patient care services as a Family Nurse Practitioner to patients with
epilepsy.




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Research Laboratories

David Prince, M.D., Pimley Professor in Neurology and Neurological Sciences, directs
and John Huguenard, Ph.D., Associate Professor of Neurology and Neurological
Sciences, co-directs the Stanford Epilepsy Research Laboratories, also comprising the
laboratories of Dr. Paul Buchmaster and Robert Fisher. The Stanford Epilepsy Center
laboratories probably have trained more distinguished epilepsy researchers than has any
other single site in the world. Some of the previous fellows have taken basic science
training in the research laboratories. Involvement in the laboratory by epilepsy fellows is
encouraged.

Clinical Facilities

An epilepsy monitoring unit for inpatient video-EEG-computerized monitoring is in full
operation. Up to five patient rooms and one portable monitoring system comprise the
unit. The epilepsy monitoring unit (EMU) performs scalp video EEG studies with 64-
128 channel recordings, studies as part of the differential diagnosis of epilepsy, stereo-
encephalographic recordings, recordings from subdural strips and grids, and stimulation
mapping for functional cortical localization. The base equipment is state-of-the-art
BMSI/Nicolet video-EEG monitoring equipment. Program faculty have been involved in
development of the EMU/Nicolet software. The monitoring unit facilitates differential
diagnosis of epilepsy, and helps to localize seizure foci by noninvasive and invasive
methods. Affiliated with the unit is a Neurosurgical group (Drs. Shuer and Hite), a
Neuropsychology group under the direction of Dr. Penelope Zeifert. A dedicated nursing
staff and EEG technology staff are devoted to the unit. Mimi Callanan and Bonnie
Pamiroyan perform nurse educator/administrator functions for the unit. Fellows are
directly involved in the management of patients, in conjunction with house staff and
attending staff.


Clinical Neurophysiology Program:

Stanford University Medical Center has an active program in clinical neurophysiology,
with emphasis on EEG, evoked potentials, intra-operative monitoring, and special EEG
studies. There is an opportunity to learn EMG and nerve conduction studies, under
guidance of Drs. Les Dorfman, Jaime Lopez, Yuen So, Charlie Cho, and staff. There are
presently 6 full-time EEG technologists. An active intra-operative evoked potential
monitoring service performs studies on a daily basis. Fellows will obtain experience with
reading of routine EEG's, ambulatory 24-hour EEG's, digital EEG outpatient recordings,
routine evoked potentials, intra-operative evoked potentials, video-EEG studies, special
invasive electrical recordings, brain stimulation mapping with a grid, computer analyzed
EEG's in various forms.

Arrangements can be made for a training experience in EMG/nerve conduction studies.
Stanford comprises a world-acclaimed Sleep Disorders Center. Training at the Sleep




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Disorder Center is not presently part of the Clinical Neurophysiology Fellowship, but
exposure can be made by special arrangement.

For two year fellows there will also be an opportunity to participate in clinical research
projects pertaining to epilepsy and EEG, or basic laboratory projects with staff. Dr.
David Prince directs a major center for basic epilepsy research, with multiple lines of
research. Dr. John Hueguenard studies the mechanisms of normal and abnormal rhythm
generation, such as spike-waves, in brain. Dr. Paul Buchmaster studies brain plasticity
after seizures and status epilepticus. Dr. Robert Fisher has projects evaluating innovative
methods for treating seizure foci, by electrical stimulation, local drug perfusion, cooling,
and other methodologies. Stanford has a very strong Neuroscience program, both within
and external to the Department of Neurology, and encourages multidisciplinary research,
involving trainees.

Structure of the Fellowship:

Preference is given to fellows who wish to make a two-year commitment, with an
emphasis on epilepsy and EEG, but one year fellowships are offered. Those wishing to
take the new AMA approved subspecialty boards in clinical neurophysiology may be
allowed to devote several months to neuromuscular studies, for training purposes and
board eligibility. Patients with epilepsy will be seen in the clinic jointly by fellows and
staff. Fellows will attend one or two seizure clinics a week, including adult and pediatric
seizure patients. From four to eight months will be spent each year in the epilepsy
monitoring unit. The remaining time will be devoted to outpatient and intraoperative
EEG studies and clinical or basic research projects.

Acceptance to the program assures a minimum of 1 year of salary, assuming satisfactory
performance. Where appropriate, application may be made to outside agencies such as
the Epilepsy Foundation of America or American Epilepsy Society for funding support to
defray costs of the fellowship. Individuals who bring their own funding may be
considered on an individual basis for special training programs.

Responsibilities

Fellows in the Stanford University Medical Center Neurophysiology Fellowship should
expect to partake of the following responsibilities:

1. EMU SCHEDULE: Serve in the Epilepsy Monitoring Unit for a maximum of eight
months in the first year, six months in the second year. While in the monitoring unit the
fellow will provide a history and physical exam on each patient admitted to the
Monitoring Unit and write admitting orders, confer with the nursing and technical staff
on the plan and montage. The fellow will interact with patients and family to help give
them an idea of what to expect in the monitoring unit, in conjunction with nursing staff.
The fellow will decide whether and to what extent to reduce antiepileptic medications.
All of the above responsibilities will be performed under the direction of the attending.




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2. EMU SEIZURE REPORTS: While participating in the Epilepsy Monitoring Unit,
typically Monday through Friday and on a rotating weekend call schedule, the fellow will
review the seizures and baseline EEG files and enter preliminary interpretations into the
Epilepsy Monitoring Unit report. These will be reviewed daily with the staff attending.
Patient orders and plans for discharge or other types of monitoring will be made after the
daily review of the EEG material.

3. PATIENT ORDERS: Both fellows and attendings may write orders on the patients in
the Epilepsy Monitoring Unit, as per agreement and unit policy. Fellows will be
responsible for preparation of the final EMU report and the usual admission and
discharge dictations. Faculty typically provide additional notes and daily chart notes.

4. GRID STIMULATION: When patients are in the monitoring unit for grid stimulation
studies, the fellow will participate in performing the stimulation in conjunction with
neuropsychologists and the attending. Such stimulation typically takes 1-2 hours per day,
but is variable depending upon the clinical question. Fellows will go into the operating
room for observation of placement of grids on sites of clinical interest, and for the second
craniotomy to remove the grid and perform the resective procedure. Fellows will work in
conjunction with neuropsychology to maintain a stimulation report and visual map of
functional regions of cortex.

5. WADA TESTING: Fellows will participate in Wada testing, also known as
intracarotid amobarbital testing. Reports will be prepared by neuropsychology.

6. SEIZURE CONSULTATION: Fellows will perform seizure consultations when
requested by the inpatient services or neurology service, and will present these cases to
the attending on the epilepsy service.

 7. INTRAOPERATIVE MONITORING OF AWAKE PATIENTS: Fellows will
participate in intraoperative monitoring of awake patients to map functional regions of
brain prior to resection. Such cases typically arise every few months.

 8. ROUTINE INTRAOPERATIVE MONITORING: Fellows will be expected to
become familiar with intraoperative evoked potential monitoring by participating in
several such studies in the operating room and interpreting the studies during the EEG
reading sessions.

9. EEG'S: On months when not in the epilepsy unit fellows will be expected to read
EEGs under a schedule to be interdigitated with neurology resident EEG training.

10. INVASIVE ELECTRODES: Fellows will be expected to gain familiarity with
placement of depth electrodes and subdural strips in seizure patients, by attending such
placements in the operating room on a few occasions, and participating in the daily
interpretation of the EEGs recorded from invasive electrodes.




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11. CLINIC: Fellows will attend seizure clinic a minimum of one day (or one afternoon)
a week. In clinic the fellows will see new and return patients. Some clinics may be at
affiliated programs in the Bay area. Some fellows may support their salaries with a
general neurology clinic, on a schedule not to intefere with the educational functions of
the Fellowship.

12. DRUG STUDIES: Fellows will participate in anti-epileptic drug studies, in some
cases including the design phase, in most cases by implementing the study with suitable
patients.

13. RESEARCH PROJECT: Fellows will develop a research project after discussion
with faculty. This may be a clinical research project, a research project based on
electroencephalography or a basic science research project. The expectation is for
abstracts, presentations at national meetings and peer reviewed publications resulting
from the research projects.

14. FELLOWSHIP SUPPORT: Application may be made for fellowship support from
outside agencies. Such outside funding is encouraged, both as an honor for the fellow
and as additional support funds for the hospital. Obtaining such funding is not, however,
required for fellows accepted into the program.

15. EMG: Fellows may elect time on the EMG-neuromuscular service if they wish to be
eligible for the AMA special expertise in Clinical Neurophysiology boards. This aspect
of the program will be individualized.

16. SLEEP DISORDERS: Some fellows may wish to spend time in the Stanford Sleep
Disorders Center. This can be accomplished by special arrangement.

17. EDUCATIONAL CONFERENCES: Fellows are invited to participate in any and all
educational conferences provided for faculty and house staff in the Departments of
Neurology, Neurosurgery, and related departments. Such participation will require a
"common sense" allocation of time in relation to other clinical responsibilities.
Typically, fellows would attend Neurology Grand Rounds, clinical case conferences, and
an individualized subset of the other daily teaching conferences in the program.

18. SEIZURE CONFERENCE: It will be the fellow's responsibility to present 1-3 cases,
or didactic topics, at the weekly seizure conferences. The fellow will generate from the
database a summary history, and arrange to present suitable Video-EEG segments for
digital display. Discussion of the case will be the responsibility of the group as a whole,
not just that of the fellow. The fellow will participate in occasional administrative
meetings.

19. FELLOWSHIP DURATION: Two year fellowships are encouraged, but one year
fellowships are also offered. A greater degree of supervisory responsibility is expected in
the second year of fellowship. A larger fraction of time should be made available for




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research projects in the second year, but this will depend upon the availability of other
fellows and house staff to work in the Epilepsy Monitoring Unit.

20. CORE COMPETENCIES:
Upon completing the Fellowship, the trainee will be expected to be able to perform the
following tasks:

1. Interpret routine adult electroencephalograms (EEGs)

2. Interpret pediatric EEGs, including neonatal studies

3. Interpret intracranial electrode recordings

4. Interpret long-term video-EEG monitoring studies

5. Interpret evoked potentials

6. Have general familiarity, though not independent competence, in nerve conduction
studies and electromyograms (EMGs)

7. Have an expert level understanding of the outpatient and inpatient management of
       patients with epilepsy

8. Be expert in clinical and EEG diagnosis of conditions that imitate epilepsy

9. Know the emergency treatment of status epilepticus

10. Be able to critically review literature pertaining to epilepsy

11. Know how to design and execute research projects in epilepsy.




Application Procedure:

For further inquiries or to apply for fellowship please write or call Dr. Robert Fisher,
Stanford Comprehensive Epilepsy Center, Room H3113, Stanford University School of
Medicine, 300 Pasteur Drive, Stanford, CA 94305-5235, 650-725-6648, e-mail
rfisher@stanford.edu. The usual schedule begins July 1st, but other starting times can be
negotiated. Selections for a July start time typically are made in Sept-November. Salaries
are commensurate with level of training, and will be discussed on an individual basis.
Stanford is an Equal Opportunity employer.

The application process consists of:




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1. curriculum vita

2. Letter, one or two paragraphs long, describing future professional goals or plans, i.e.,
what your training will be for. We will not hold you to this letter.

3. Two or three letters of recommendation, addressed via email or printed mail to:
       Robert S. Fisher, M.D., Ph.D.
       Maslah Saul Professor of Neurology
       Stanford Neurology, Room A343
       300 Pasteur Drive
       Stanford, CA 94305-5235
       650-725-6648
       fax 650-498-6326
       robert.fisher@stanford.edu




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