Stanford Comprehensive Epilepsy Program Adult Fellowship

Goals of Training

There is a rich history of postgraduate training in epilepsy at Stanford University since the 1950’s. In the late 1980’s, a formal 2-year clinical fellowship training program became distinct from basic science training. We currently have funding for training in both ACGME accredited Epilepsy and Clinical Neurophysiology pathways, the latter generally only available to applicants for a 2-year program.

We aim to train fellows to become academic epileptologists and leaders in the field with a wide range of skills including:

1) diagnosis and treatment of patients with various types of epilepsy syndromes with emphasis on medically refractory cases (a third of the epilepsy population), including outpatient and inpatient management, and including skills in planning and programming neuromodulation (VNS, RNS, DBS);

2) interpretation of EEG, including: routine; long-term records with video including those of patients with seizure-like symptoms, clear epilepsy for the purposes of seizure localization, and of critically ill patients; intracranial recordings to localize seizures and map function; source analysis of high-density EEG; and EEG screening with emerging technology;

3) the presurgical evaluation of patients with medically refractory focal epilepsy, including the understanding of additional diagnostic tests (anatomical and functional MRI of the brain, FDG PET co-registered to CT and MRI of the brain, ictal SPECT, role of MEG, Wada testing, neuropsychological testing and others), and becoming expert in the synthesis of data and planning of treatment options;

4) identification of illnesses that mimic epilepsy;

5) understanding and treatment of co-morbidities of epilepsy syndromes;

6) participating in meetings including epilepsy surgery case conference and didactic teaching conferences on a wide array of topics;

7) reading, understanding and critiquing relevant literature; and

8) training in research methods including designing and executing a research project(s) relevant to epilepsy.

Facilities

Stanford Health Care is located in Palo Alto, California and serves as a premier referral center for patients with neurological and neurosurgical disorders. A new 824,000 square-foot hospital addition is active as of October 2019, with a 10-bed state of the art epilepsy monitoring unit and new neurointensive care unit.

SMC has available superb neuro-radiology facilities including CT, 1.5, 3 and 7 Tesla MRI, 3-dimensional MRI angiography, functional MRI, SPECT, and FDG PET-MRI, and investigational imaging technologies. Interventional neuroradiology for vascular disease is also performed.

Outpatient epilepsy clinics are active Monday through Friday in a new state of the art Neuroscience Health Center building. Multiple teaching conferences occur almost every day, spanning the areas of clinical neurology, epilepsy and EEG, cerebrovascular disease, pediatric neurology, neuropathology, neuropsychology, neuroradiology, neurosurgical case management, and research issues.

Fellowship Structure

Preference is given to fellows who wish to make a two-year commitment, with an emphasis on epilepsy and EEG, but one-year fellowships are also offered. We strive to maintain a complement of 5-6 fellows divided between the first and second year, in addition to pediatric fellows and basic science research fellows. Patients with epilepsy will be seen in the clinic jointly by fellows and staff. Fellows rotate through rotations on 1) the epilepsy monitoring unit, 2) off service inpatient EEG, 3) outpatient EEG and epilepsy clinic, 4) pediatric EEG and clinic, and 5) elective rotations. All fellows engage in research projects and prepare scholarly presentations.

Acceptance to the program assures a minimum of 1 year of salary, assuming satisfactory performance. Where appropriate, application may be made to outside agencies such as the Epilepsy Foundation of America or American Epilepsy Society for funding support to defray costs of a second-year fellowship. Individuals who bring their own funding may be considered on an individual basis for special training programs.

Application may be made for fellowship support from outside agencies. Such outside funding is encouraged, both as an honor for the fellow and as additional support funds for our program. Obtaining such funding is not, however, required for fellows accepted into the program. Exceptional candidates are always encouraged to inquire if expansion is possible.