The CNP-EEG fellowship begins with a two-month Clinical Neurophysiology Introductory Course covering all areas of clinical neurophysiology. The anatomy, physiology, pathophysiology and clinical neurophysiological features of disease are emphasized, along with the technical aspects of testing methods.
During the subsequent months you will alternate rotations in the EEG laboratory and epilepsy services.
EEG: During the time spent in the EEG lab, you will interpret a large number of EEG records from adults and children with a wide variety of disorders. During the subsequent months in EEG, you will be given increasingly independent responsibility to oversee complex problems, take emergency call, oversee and perform prolonged EEG and surgical monitoring, learn about evoked potentials, teach new residents, and present lectures and seminars.
There is a strong emphasis on EEG of seizure disorders. You will be exposed to a variety of seizure problems, the monitoring techniques used to evaluate patients with seizure disorders (including prolonged monitoring and ambulatory monitoring), and techniques used for recording during surgery. You will also see and interpret EEGs with a wide variety of other patterns during the EEG rotation.
During the fellowship, you will have the opportunity to rotate to the EMG or sleep labs, or with the Intraoperative Monitoring (IOM) services, to get a broad experience in clinical neurophysiology.
Epilepsy: During the time spent on the epilepsy services, you will take care of patients on the inpatient epilepsy monitoring service, see patients in the epilepsy outpatient clinic, and see patients on the hospital epilepsy consulting service.
- The schedule of clinical activities is designed to achieve a balance between outpatient and inpatient EEG and patient care, and to ensure that you have experience with different aspects of epilepsy care and EEGs. You will work with both adult and pediatric patients, and will be involved with drug therapy and/or surgical treatment for new-onset seizures or for refractory epilepsy.
The rotations are designed so you will have gradually increasing responsibilities in these areas. By the end of your fellowship, you should be able to perform these activities independently.
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. There is a weekly multi-disciplinary Epilepsy Surgery Conference. In addition, a patient problem-oriented Journal Club, for epilepsy and EEG, meets on alternate months.
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 other weekly seminars and conferences in neurology, 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.
Regardless of the 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 it 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.
You will have the opportunity to study in Mayo Clinic's EMG laboratory 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
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.
Elective rotating in the Sleep Disorders center are available, in order to gain 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:
- Sleep apnea syndrome
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.
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 & 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 formal clinical neurophysiology will also be considered.
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
- Thermoregulatory sweat test