Clinical Neurophysiology Fellowship

The Clinical Neurophysiology Fellowship at Allegheny General Hospital is under the direction of George A. Small, M.D., program director.  This program provides a PGY V level of training for one year and is divided equally between acquisition of knowledge in electroencephalography (EEG)/evoked potentials (EP) and electromyography (EMG)/nerve conduction velocity (NCV) studies.  The program is comprised of approximately five months each of EEG and EMG.  The remaining two months are available for electives, which can include pediatric neurophysiology, neurorehabilitation, polysomnography, botulinum toxin administration, and intraoperative monitoring experience.

More than 1800 EEGs are performed yearly at Allegheny General Hospital, including both inpatient and outpatient.  The fellow will be responsible for reviewing these EEGs, and will be supervised in their interpretations by Dr. James Valeriano or Dr. Kevin Kelly, both of whom are fellowship-trained experts in EEG/EP interpretation.  The fellow will also gain experience in the epilepsy monitoring unit (EMU), including the placement of sphenoidal electrodes and interpreting video-EEGs used to assess candidates for epilepsy surgery.  24-hour ambulatory EEGs are also performed in the laboratory, and the fellow will also obtain experience in interpreting these studies.  In addition, the fellow will be responsible for making rounds on inpatients in the EMU on a daily basis, reviewing video-EEG records, and participating in epilepsy case conference in which surgical candidates are discussed, along with other relevant topics in epilepsy.  The fellow will attend these conferences and will also be expected to present epilepsy surgery cases.

The fellow will attend epilepsy clinic to gain clinical experience in managing patients with epilepsy.  This will include patients who are post-operative epilepsy surgery patients, patients on various medical regimens, including patients involved in drug studies, and patients with vagus nerve stimulators.

More than 1300 EMG/NCV studies are performed yearly under the direction of Drs. George Small and Sandeep Rana. The fellow will progress rapidly to design, perform, and interpret these studies. Our large population of patients with motor neuron disease, myasthenia gravis, and peripheral neuropathy provide a wide range of experience for the fellow’s training. In addition, Dr. Rana is clinic head for the region’s largest ALS center, and both Drs. Small and Rana are listed as specialists in peripheral neuropathy from The Neuropathy Association, the largest general resource regarding this condition in the United States. The neurophysiology fellow’s laboratory experience is strengthened by patient referrals from the faculty’s participation in these organizations.

Opportunities to evaluate patients in the ALS clinic, neuromuscular clinic, and Botox clinic provide the fellow with the clinical correlations necessary to complement his/her understanding of the tests performed. In addition, several lecture series, including weekly EEG and EMG seminars, provide the didactic instruction necessary for proper performance and study interpretation.

The Autonomic Neurophysiology Laboratory opened in 2005, allowing the neurophysiology fellow additional extra experience in diagnosing patients with cardioadrenergic, cardiovagal, and small fiber pathology. Use of tilt-table analysis, R-R interval and Valsalva testing, and QSART testing enhances the diagnostic sensitivity of testing for patients with unexplained syncope and idiopathic peripheral neuropathy.

The American College of Graduate Medical Education (ACGME) through the American Board of Medical Specialties (ABMS) certifies the clinical neurophysiology fellowship. Upon successful completion of the fellowship, the candidate is eligible to sit for the added Qualification examination in Clinical Neurophysiology, as well as the American Board of Electrodiagnostic Medicine (ABEM) examination.