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VA Neurophysiology

Please contact Dr. Cupka and Dr. Zilliox (Brian.Cupka@va.gov, Lzilliox@som.umaryland.edu) two weeks before the start of your rotation to set up a time to meet with one of them to discuss the schedule. They will meet with you before the rotation starts or on the first day of the rotation to review the schedule.

  • Dr. Cupka almost always has EMGs all day on Thursdays and Fridays

  • Dr. Konikkara almost always reads sleep studies Tuesday mornings and has sleep clinic Tuesday afternoons, both of which are helpful and educational

  • Dr. Porter almost always has AM Frenkil clinic on Mondays

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.


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, 2019