Of Hearth and Home: Professional Wellness After Hours.

Burnout is a prevalent problem in the contemporary practice of medicine. Defined by the Agency for Healthcare Research and Quality as, "a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment," this multifactorial condition has significant implications for the clinicians who suffer it, their patients, and families. Neurologists suffer some of the highest rates of burnout.

Equipment Setup and Artifact Removal for Simultaneous Electroencephalogram and Functional Magnetic Resonance Imaging for Clinical Review in Epilepsy.

Simultaneous electroencephalogram and functional magnetic resonance imaging (EEG-fMRI) is a unique combined technique that provides synergy in the understanding and localization of seizure onset in epilepsy. However, reported experimental protocols for EEG-fMRI recordings fail to address details about conducting such procedures on epilepsy patients. In addition, these protocols are limited solely to research settings.

Focal epilepsies: Update on diagnosis and classification.

Correctly diagnosing and classifying seizures and epilepsies is paramount to ensure the delivery of optimal care to patients with epilepsy. Focal seizures, defined as those that originate within networks limited to one hemisphere, are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic-clonic seizures. Focal epilepsies account for most epilepsy cases both in children and adults.

Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States.

Background And Objectives: Persons with epilepsy, especially those with drug resistant epilepsy (DRE), may benefit from inpatient services such as admission to the epilepsy monitoring unit (EMU) and epilepsy surgery. The COVID-19 pandemic caused reductions in these services within the US during 2020. This article highlights changes in resources, admissions, and procedures among epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC).

Incident epilepsy in the cognitively normal geriatric population, irrespective of seizure control, impairs quality of life.

Purpose Of The Research: The geriatric population is the fastest-growing population in the United States and the impact of incident epilepsy on the cognitively intact geriatric population is not well-studied. Understanding how epilepsy affects the elderly is important to improve the quality of treatment and care for our aging population. This study sought to address the impact of incident epilepsy on the perceived Quality of Life (QOL) in cognitively intact elderly using the SF-36 questionnaire.

United States Epilepsy Center Characteristics: A Data Analysis From the National Association of Epilepsy Centers.

Background And Objectives: Patients with drug-resistant epilepsy (DRE) may benefit from specialized testing and treatments to better control seizures and improve quality of life. Most evaluations and procedures for DRE in the United States are performed at epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC). On an annual basis, the NAEC collects data from accredited epilepsy centers on hospital-based epilepsy monitoring unit (EMU) size and admissions, diagnostic testing, surgeries, and other services.

Approach to Loss of Consciousness: Distinguishing Epileptic Seizures, Psychogenic Nonepileptic Seizures, and Syncope.

Transient loss of consciousness (TLOC) is a common emergent neurological issue, which can be attributed to syncope, epileptic seizures, and psychogenic nonepileptic seizures. The purpose of this article is to outline an approach to diagnosing the most common etiologies of TLOC by focusing on the importance of the history and physical examination, as well as targeted diagnostic tests.

Clinical Neurophysiology Fellowship Program Directors Survey on a Standardized Fellowship Match Process: A Call for Action.

Purpose: To survey US Clinical Neurophysiology (CNP) fellowship program directors on the nature of CNP and related training programs, current recruitment cycle, and views for a standardized process.

Methods: A 23-question electronic survey was sent to all 93 US Accreditation Council for Graduate Medical Education-accredited CNP fellowship program directors from December 2020 to January 2021.

Results: The response rate was 60%.

Artifacts That Can Be Misinterpreted as Interictal Discharges.

It is presumed that the EEG records only cerebral activity. However, frequently it can include other electrical activities, referred to as noise or artifact, which are not of cerebral origin. In the last few decades, evolution in digital technology has greatly improved the ability to record and display interpretable EEG.

Status epilepticus alert reduces time to administration of second-line antiseizure medications.

Background: Status epilepticus (SE) is a neurologic emergency with high morbidity and mortality. Delays in SE treatment are common in clinical practice and can be associated with poorer outcomes. Our goal was to determine whether the implementation of an SE alert protocol improves time to administration of a second-line antiseizure medication (ASM) in hospitalized adults.

Evaluating an Interdisciplinary EEG Initiative on In-Training Examination EEG-Related Item Scores for Anesthesiology Residents.

Purpose: Clinical neurophysiology is an evolving area of medicine with clinical applications in intensive care unit and intraoperative settings, where EEG is used. An interdisciplinary module was implemented over 7 years in one institution to strengthen anesthesiology residents' EEG education. This study researched the module's outcome by evaluating participants' specific performance on EEG-related questions (keywords) through independent testing, i.

Noninvasive seizure prediction using autonomic measurements in patients with refractory epilepsy.

There is resurgent interest in the role played by autonomic dysfunction in seizure generation. Advances in wearable sensors make it convenient to track many autonomic variables in patient populations. This study assesses peri-ictal changes in surrogate measures of autonomic activity for their predictive value in epilepsy patients.

Pharmacokinetics and Clinical Utility of Valproic Acid Administered via Continuous Infusion.

Introduction: Valproic acid is a versatile antiepileptic drug that is often used in the acute care setting. Intravenous valproic acid lends itself well to a continuous infusion as it exhibits a relatively short half-life. We evaluated the pharmacokinetics and clinical efficacy of continuous infusion valproic acid in hospitalized patients with migraine and seizures.

Prior Podcast Experience Moderates Improvement in Electroencephalography Evaluation After Educational Podcast Module.

Background: There is continued interest in using technology to enhance medical education and the variables that may affect its success.

Methods: Anesthesiology residents and fourth-year medical students participated in an electroencephalography (EEG) educational video podcast module. A 25-item evaluation tool was administered before any EEG education was provided (baseline), and the podcast was then viewed.

Tonic glutamate in CA1 of aging rats correlates with phasic glutamate dysregulation during seizure.

Objective: Characterize glutamate neurotransmission in the hippocampus of awake-behaving rodents during focal seizures in a model of aging.

Methods: We used enzyme-based ceramic microelectrode array technology to measure in vivo extracellular tonic glutamate levels and real-time phasic glutamate release and clearance events in the hippocampus of awake Fischer 344 rats. Local application of 4-aminopyridine (4-AP) into the CA1 region was used to induce focal motor seizures in different animal age groups representing young, late-middle aged and elderly humans.

The impact of an interdisciplinary electroencephalogram educational initiative for critical care trainees.

Purpose: The purpose of this study is to evaluate the effectiveness of an interdisciplinary electroencephalogram (EEG) educational module for critical care training. Electroencephalogram is increasingly used for diagnosis, monitoring, and treatment decisions in critically ill patients with neurologic and nonneurologic disorders. Continuous EEG monitoring has an expanded role in the intensive care unit as an additional evaluation tool for critically ill patients with altered mental status.

Evaluating the long-term retention of a multidisciplinary electroencephalography instructional model.

Background: Clinical decision making and problem solving require a core of basic factual knowledge that must be accessed sometimes months or years after it has been learned. We examined whether 10 compared with 20 total electroencephalogram (EEG) interpretations impacted scores for long-term retention with the residents in the 20 total EEG group assessed with additional examinations.

Methods: Study participants interpreted 10 (10 EEG group) or 20 (20 EEG group) EEGs during a month rotation.

Education research: evaluating the use of podcasting for residents during EEG instruction: a pilot study.

Objective: Educational methods for residents are shifting toward greater learner independence aided by technological advances. A Web-based program using a podcast was created for resident EEG instruction, replacing conventional didactics. The EEG curriculum also consisted of EEG interpretations under the tutelage of a neurophysiologist.

The effectiveness of an interdisciplinary approach to EEG instruction for residents(r).

Expanding EEG use calls for education during postgraduate training. We performed a study to see whether an innovative, interdisciplinary approach to EEG instruction for residents achieved curriculum goals of increasing knowledge of EEG use and interpretation. A 45-minute EEG educational module was developed by a clinical neurophysiologist and a neurocritical care anesthesiologist.

Sporadic Creutzfeldt-Jakob disease presenting as nonconvulsive status epilepticus case report and review of the literature.

Creutzfeldt-Jakob disease (CJD) is the most common transmissible human spongiform encephalopathy. Seizures and status epilepticus (SE) are an uncommon finding in CJD. We report a 64-year-old woman with rapid cognitive decline who had electroencephalographic (EEG) changes suggestive of nonconvulsive status epilepticus (NCSE).

Evaluating the requirements of electroencephalograph instruction for anesthesiology residents.

Background: During a 1-mo neurosurgical intensive care unit rotation, anesthesiology residents interpret electroencephalograms (EEGs) performed throughout the institution, including intraoperative EEGs. The curriculum goal is to increase familiarity with EEG use and interpretation with 20 EEG interpretations with a clinical neurophysiologist during this rotation. We aimed to determine whether the EEG curriculum goals could be achieved with fewer EEG interpretations.

Induction of progressive profound hypocitraturia with increasing doses of topiramate.

Objectives: To provide prospective, longitudinal evidence of the effects of topiramate, an antiepileptic medication prescribed for migraine headaches, on stone-risk factors, specifically as pertaining to dosing and rapidity of onset.

Methods: Patients scheduled to begin topiramate therapy were recruited to participate in the study. Enrolled subjects collected a pretreatment 24-hour urine specimen with subsequent 24-hour urine specimens collected 5 days after beginning topiramate and after each dose escalation.

Continuous spikes and waves during slow sleep in an adult.

Continuous spikes and waves during slow wave sleep (CSWS) is rare and is considered to be an age-related epileptic syndrome occurring only in children. We report the case of a 21-year-old patient diagnosed with this syndrome. The patient had a history of seizures since the age of 3 and was admitted for continuous video/EEG monitoring to evaluate seizure exacerbation and unprovoked outbursts of anger.