Curriculum

The Neurophysiology, Electromyography Fellowship curriculum is flexible, and any of these areas may be emphasized, depending on your individual interests and needs.

Clinical Training
The clinical experience during the EMG fellowship includes direct training under the supervision of the consultants working in the electromyography laboratory. By the time you successfully complete your training, you will have participated in the clinical evaluation and have performed studies on patients with all types of neuromuscular disorders, including:

• Spine and limb disorders
• Peripheral neuropathy
• Myopathy
• Motor neuron disease
• Disorders of neuromuscular transmission

First Six Months
The fellowship begins with a two-month Clinical Neurophysiology Introductory Course. The course is a formal didactic program covering all areas of clinical neurophysiology. You will study the anatomy, physiology, pathophysiology, pathology and clinical neurophysiological features of disease while learning basic EMG methodologies. Tests in these areas will be given before you may perform clinical studies on patients.

The next four months will be spent performing patient EMG studies, refining your clinical skills and gaining experience with a variety of neuromuscular disorders. You also will participate in didactic sessions and present occasional conferences.

Second Six Months
During the second six months, you will have the opportunity to learn more advanced techniques - including single-fiber electromyography, evoked potentials and intraoperative neurophysiological monitoring.

You will perform EMG studies on patients with more complicated muscular problems, as well as on pediatric patients. You will have increasing responsibility to work independently on most problems. If you wish, you can gain experience in quantitative sensory testing, autonomic testing and intraoperative monitoring. There are also opportunities for some participation in muscle and nerve biopsy reading sessions - although this fellowship is not intended to provide competence in these areas.

The EMG Fellowship also provides the opportunity to rotate to the EEG lab and movement disorders lab to get a broad experience in clinical neurophysiology.

In the last six months, you will assume increased responsibility for patients' clinical care and help supervise other EMG trainees. You also will prepare a variety of seminars and lectures for other residents. By the end of one year, you will have presented several conferences on major topics in clinical electromyography.

Throughout your fellowship you will have the opportunity to see patients in the neuromuscular clinic.

Didactic Training
Clinical conferences, lectures, lecture-demonstrations, seminars, small discussion groups, and one-on-one instruction are all an integral part of Mayo Clinic's clinical neurophysiology programs. You will have the opportunity to attend weekly conferences in both the EEG and EMG laboratories.

These conferences include clinical EEG and EMG case reports, lectures and lecture-demonstrations about:

• Electronics and instrumentation
• Evoked potential studies
• Autonomic function studies
• Basic neurophysiology

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

During your clinical neurophysiology fellowship, you will participate in a series of formal didactic sessions and regularly scheduled conferences in all aspects of clinical neurophysiology. There are regular conferences in EEG, EMG epilepsy, neuromuscular and peripheral nerve disorders, movement disorders and sleep disorders. Opportunities for teaching and research also are available.

Research Training
Regardless of the neurophysiology fellowship you select, you are encouraged to complete at least one investigative project during your training. The type of research project you select will depend on your interests and capabilities and the time available in your program. Opportunities are available for collaborative studies with other clinical and basic science sections at Mayo Clinic.

When you complete your research, you will be expected to present the findings at a scientific meeting or prepare it for publication in a scientific journal. This experience teaches you how to comprehend and critically evaluate other reported investigations and gain insight into the conduct and principles of research.

Additional Training

Evoked Potentials
You will have the opportunity to study in Mayo Clinic's EMG and EEG laboratories learning about the techniques and interpretation of evoked potential studies. This includes exposure to:

• Brainstem auditory evoked responses
• Pattern reversal visual evoked responses
• Somatosensory evoked potentials

Movement Disorders
In Mayo Clinic's EEG and EMG laboratories, you also can learn about techniques for assessing movement disorders - including tremors, myoclonus, seizures, botulinum injections and others.

Sleep Disorders Center
The Mayo Clinic Sleep Disorders Center is a multidisciplinary center staffed by consultants in pulmonary medicine, neurology and psychiatry.

If you enroll in the two-year program, you may spend time in the center, gaining experience in performing and interpreting nocturnal polysomnography and multiple sleep latency tests. Here, you also have the opportunity to see patients with a wide variety of sleep disorders, including:

• Narcolepsy
• Sleep apnea syndrome
• Parasomnia
• Insomnia

A separate one-year fellowship in sleep disorders medicine also is available, which fulfills training requirements for certification by the American Board of Sleep Medicine.

Also see:

• Mayo Clinic's Sleep Medicine Fellowship.

Pediatric Epilepsy
The Mayo Clinic Pediatric Epilepsy Fellowship is designed for individuals who have one year of EEG/Clinical Neurophysiology training. The one-year fellowship is equally divided into clinical and research training. The clinical training includes outpatient pediatric epilepsy clinic and inpatient video EEG monitoring.

You will gain experience in presurgical evaluation including MRI, MRS, ictal and interictal SPECT, PET, extra-operative electrocorticography and functional mapping, as well as the ketogenic diet and use of the vagus nerve stimulator. Opportunities for epilepsy related research include epidemiology, genetics, clinical electrophysiology and behavior. Individuals who have not had a year of clinical neurophysiology will also be considered.

Also see:

•  Mayo Clinic's Pediatric Epilepsy Fellowship .

Autonomic Laboratory
If you would like experience in the autonomic laboratories, you can arrange a time in these areas before or after completing your clinical neurophysiology fellowship. This three-month experience includes lectures, supervised reading, training in autonomic testing, and possibly a research project under the supervision of staff. Mayo Clinic's autonomic laboratory has three clinical components:

• Clinical autonomic laboratory
• Research and development autonomic laboratory
• Thermoregulatory laboratory

Routine tests performed in the clinical autonomic reflex laboratories include:

• QSART (quantitative sudomotor axon reflex test)
• Orthostatic BP and HR response to tilt
• Heart rate (HR) and response to deep breathing (HRDB)
• The valsalva ratio (VR)
• Beat-to-beat BP (BPBB) to valsalva maneuver, tilt and deep breathing
• Salivation test
• Tests to detect sympathetically maintained pain or reflex sympathetic dystrophy
    (RSD)
  - Telethermography or infrared thermometry
  - Resting sweat output
  - QSART
• Thermoregulatory sweat test
  This three month experience in the autonomic laboratories include lectures, supervised reading, training in autonomic testing and possibly a research project under the supervision of staff.