VA Neurophysiology

Please contact Dr. Cupka and Dr. Khan (Brian.Cupka@va.gov) about one to two weeks before the start of your rotation to let them know that you will be joining.

During this block you will have the opportunity to work with Dr. Cupka (NM), Dr. Khan (Epilepsy), Dr. Konikkara (Sleep/Epilepsy), and Dr. Porter (NM at University). You will also have Frenkil clinic sessions (typically two), so please check your Epic Schedule. In addition, Dr. Shergelashvili has joined the NM team at the VA as of August 2024, which may present additional educational opportunities moving forward.

Schedules

You have to spend at least 3 half days at the VA, but the schedule is amenable to some personalization. For example, if there is an attending in Frenkil clinic performing studies, you are welcome to customize your schedule to work with them. The Frenkil clinic attendings have more variability in their schedules.

If you are so inclined, you can insert more EEG time into your schedule. You can discuss with Dr. Hopp if you'd like to do that.

EMG/NCS

Dr. Cupka has EMG/NCS all day Thursday and Friday at the VA.

Dr. Porter’s clinic schedule varies depending on whether or not he is on service. Please check his schedule in Epic. If there are PGY2s in with him, you should give them priority.

Sleep Medicine

Attendings: Dr. Konikkara, Dr. Hasan Ercan and Dr. Arif Kabir

If you plan on being in clinic with them, please email beforehand and they will let you know which patients are to be seen.

  • Dr. Ercan is available on Friday mornings. Contact - Hasan.Ercan@va.gov

  • Dr. Kabir on 2nd and 3rd Tuesday afternoons. Contact - Arif.Kabir2@va.gov

  • Dr. Konikkara has two fellows this year (2024-25). Residents can see patients in the fellow clinic on Friday afternoons. Contact info: John.Konikkara@va.gov

Epilepsy

Dr. Khan

Contact info: Omar.Khan2@va.gov

Please reach out to him directly for his schedule.

SYLLABUS 

This rotation will have 1 clinical component in a weekly sleep clinic and 2-3 neurophysiology components: Polysomnography, EMG, and optional EEG. The EEG component is encouraged for residents with limited EEG comfort or EMU exposure in the PGY-4 year.

EMG:

  1. Perform a focused history and examination to develop a differential diagnosis, prior to the EMG.

  2. Utilize the history, examination, and differential to design an appropriate study for each patient.

  3. Nerve conduction studies

    1. Learn the standard nerves included in most studies

    2. Understand the meaning and  importance of different measurements (i.e. distal latency, amplitude, conduction velocity)

    3. Understand the concept of F waves

  4. Electromyography

    1. Learn the standard muscles included in most studies.

    2. Identify and understand the meaning of spontaneous activity (i.e. fibrillations, positive sharp waves, etc).

    3. Identify and understand the characteristics of motor unit action potentials (i.e recruitment, amplitude, duration, polyphasia).

    4. Improve understanding of nerve root and peripheral nerve innervation for standard muscles.

    5. If allowed by the patient, attempt to perform needle EMG on easily accessed muscles (i.e. biceps, deltoid).

  5. If applicable, observe and understand less common techniques such as repetitive nerve stimulation

  6. Identify contraindications/limitations to nerve conduction studies and electromyography, such as in patients on anticoagulation, with history of spinal fusion, etc.

  7. Learn appropriate indications for EMG/nerve conduction studies

SLEEP:

  1. Attend weekly sleep clinic

  2. Learn to take a complete and accurate sleep history and physical examination

    1. Understand differential of hypersomnia

    2. Understand differential of insomnia

  3. Learn basic identification and management of Sleep Apnea

    1. See 5 patients for OSA evaluation

    2. Indications for CPAP

    3. Indications for positional device

    4. Indications for dental device

  4. Learn basic management of insomnia

    1. See 2-3 patients for insomnia evaluation

    2. Sleep Hygiene

    3. Indications for Stimulus Control

    4. Indications for CBT-Insomnia

    5. Indications for Medical management

  5. Learn indications for sleep studies

    1. Home sleep testing vs. Polysomnogram

    2. Indications for MSLT and MWT

  6. Become familiar with other primary sleep disorders

    1. Parasomnias (See one patient)

    2. RLS/PLMD (See one patient)

    3. Narcolepsy/Idiopathic Insomnia (see one patient)

  7. Develop basic PSG reading skills      

    1. Review 4 sleep studies

      1. Sleep staging

      2. Identifying sleep related events (Respiratory, limb movement)

      3. Clinical correlation

EEG

  1. Increase familiarity with Basic EEG reading skills developed in EEG rotation

    1. Please see EEG rotation goals

 

Last Updated: August 22, 2024