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:
Perform a focused history and examination to develop a differential diagnosis, prior to the EMG.
Utilize the history, examination, and differential to design an appropriate study for each patient.
Nerve conduction studies
Learn the standard nerves included in most studies
Understand the meaning and importance of different measurements (i.e. distal latency, amplitude, conduction velocity)
Understand the concept of F waves
Electromyography
Learn the standard muscles included in most studies.
Identify and understand the meaning of spontaneous activity (i.e. fibrillations, positive sharp waves, etc).
Identify and understand the characteristics of motor unit action potentials (i.e recruitment, amplitude, duration, polyphasia).
Improve understanding of nerve root and peripheral nerve innervation for standard muscles.
If allowed by the patient, attempt to perform needle EMG on easily accessed muscles (i.e. biceps, deltoid).
If applicable, observe and understand less common techniques such as repetitive nerve stimulation
Identify contraindications/limitations to nerve conduction studies and electromyography, such as in patients on anticoagulation, with history of spinal fusion, etc.
Learn appropriate indications for EMG/nerve conduction studies
SLEEP:
Attend weekly sleep clinic
Learn to take a complete and accurate sleep history and physical examination
Understand differential of hypersomnia
Understand differential of insomnia
Learn basic identification and management of Sleep Apnea
See 5 patients for OSA evaluation
Indications for CPAP
Indications for positional device
Indications for dental device
Learn basic management of insomnia
See 2-3 patients for insomnia evaluation
Sleep Hygiene
Indications for Stimulus Control
Indications for CBT-Insomnia
Indications for Medical management
Learn indications for sleep studies
Home sleep testing vs. Polysomnogram
Indications for MSLT and MWT
Become familiar with other primary sleep disorders
Parasomnias (See one patient)
RLS/PLMD (See one patient)
Narcolepsy/Idiopathic Insomnia (see one patient)
Develop basic PSG reading skills
Review 4 sleep studies
Sleep staging
Identifying sleep related events (Respiratory, limb movement)
Clinical correlation
EEG
Increase familiarity with Basic EEG reading skills developed in EEG rotation
Please see EEG rotation goals
Last Updated: August 22, 2019