Mary Kay Floeter, MD, PhD,
Susumu Sato, MD
Entry Id: TP-39

Eligibility Criteria
Qualified candidates must complete neurology residency training or the equivalent before entering this program.

Overview
The training program for clinical neurophysiology is affiliated with the Neurology residency program of the National Naval Medical Center in Bethesda, MD, and is ACGME certified. The candidates who complete this training program are eligible for examinations given by the American Board of Psychiatry and Neurology for certification in Clinical Neurophysiology, the American Board of Clinical Neurophysiology, and the American Board of Electrodiagnostic Medicine. Basic requirements for applicants include completion of an accredited Neurology residency and a valid, unrestricted US medical license.

There are two fellowship pathways. In the Clinical Neurophysiology program: the Clinical Fellow is exposed to a variety of physiological techniques, but has a primary focus in: Electroencephalography, or Electromyography, depending on the type of appointment. As well as involvement in the daily performance and interpretation of EEG and EMG studies, there is the opportunity for involvement in sleep monitoring, intraoperative monitoring, long-term noninvasive monitoring, invasive monitoring, and motor control research. The Fellow may have inpatient and outpatient responsibilities. Didactic opportunities include a weekly EEG-EMG conference, in which the EEG and EMG laboratories alternately present interesting cases, and at which invited lecturers speak and many relevant conferences and seminars in the larger NIH community.

Electroencephalography and Clinical Neurophysiology
Susumu Sato, M.D., Director
The program in Electroencephalography and Clinical Neurophysiology is combined with that of the Epilepsy Research Branch. The combined training program is for two years. The first year is usually spent in clinical epilepsy training with the Epilepsy Research Branch. The second year is spent in the Electroencephalography Section during which the Clinical Fellow is responsible for the daily interpretation of EEGs, evoked-response recordings, sleep recordings, and other EEG or neurophysiological studies associated with research projects, such as intracarotid sodium amobarbital injection, electrocorticography during epilepsy surgery, and intraoperative evoked responses. The Fellow reviews the neurophysiological studies on a daily basis, prepares a presentation for an EEG conference on alternate weeks, and presents the results of clinical neurophysiological studies on epilepsy patients at regularly scheduled multidisciplinary presurgical conferences.

Electrodiagnostic Medicine
Tanya Lehky, M.D., Director
In the fellowship pathway focusing on Electrodiagnostic Medicine, the Clinical Fellow is responsible for the daily performance and interpretation of EMGs during the first year. The fellow also has EMG and neuromuscular clinics at the National Naval Medical Center and Children's National Medical Center. There are opportunities to learn a wide variety of techniques including single-fiber EMG, quantitative motor unit analysis, and transcranial magnetic stimulation. The fellow reviews the neurophysiological studies with the laboratory chief on a daily basis, and prepares a presentation for an EMG conference on alternate weeks. Regular attendance at EEG readings is expected. The training period is two years. In the second year, advanced diagnostic techniques are mastered, but most of the time is spent on research projects that focus on spinal and peripheral mechanisms of motor control in the laboratory of Dr. Mary Kay Floeter. The fellow is also encouraged to enroll in courses, such as the Core Course in Clinical Research.

• Susumu Sato, M.D.  Pathophysiology of epilepsy, diagnosis and treatment, surgical treatment of epilepsy, intensive monitoring, chronic subdural monitoring, magnetoencephalography, and electroencephalography.
• Tanya Lehky, M.D.  Neurophysiology and Neuroimmunology.
• Mary Kay Floeter, M.D., Ph.D.  Investigations of spinal circuits and motoneurons in neurological disorders.

Selected Papers Authored by Program Faculty

• Bagic A, Boudreau EA, Greenfield J, Sato S. Electro-clinical evolution of refractory non-convulsive status epilepticus caused by West Nile virus encephalitis. Epileptic Disord. 2007 Mar;9(1):98-103. Epub 2007 Feb 15.
• Heiss JD, Walbridge S, Morrison P, Hampton RR, Sato S, Vortmeyer A, Butman JA, O'Malley J, Vidwan P, Dedrick RL, Oldfield EH. Local distribution and toxicity of prolonged hippocampal infusion of muscimol. J Neurosurg. 2005 Dec;103(6):1035-45.
• Pearl PL, LaFleur BJ, Reigle SC, Rich AS, Freeman AA, McCutchen C, Sato S. Sawtooth wave density analysis during REM sleep in normal volunteers. Sleep Med. 2002 May;3(3):255-8.
• Ko DY, Kufta C, Scaffidi D, Sato S. Source localization determined by magnetoencephalography and electroencephalography in temporal lobe epilepsy: comparison with electrocorticography: technical case report. Neurosurgery. 1998 Feb;42(2):414-21.
• Lupu VD, Mora CA, Dambrosia J, Meer J, Dalakas M, Floeter MK. Terminal latency index in neuropathy with antibodies against myelin-associated glycoproteins. Muscle Nerve. 2007 Feb;35(2):196-202.
• Bai O, Vorbach S, Hallett M, Floeter MK. Movement-related cortical potentials in primary lateral sclerosis. Ann Neurol. 2006 Apr;59(4):682-90.
• Floeter MK, Zhai P, Saigal R, Kim Y, Statland J. Motor neuron firing dysfunction in spastic patients with primary lateral sclerosis. J Neurophysiol. 2005 Aug;94(2):919-27.
• Lehky TJ, Leonard GD, Wilson RH, Grem JL, Floeter MK. Oxaliplatin-induced neurotoxicity: acute hyperexcitability and chronic neuropathy. Muscle Nerve. 2004 Mar;29(3):387-92.

Program Graduates
The following are recent graduates and their current positions on completing the Clinical Neurophysiology fellowship:

Completed Program 2007:

• Sadat Shamim, M.D., Private practice. Epilepsy and Clinical Neurophysiology.

Completed Program 2006:

• Zoltan Mari, M.D., Assistant Professor, Johns Hopkins University.
• Clarissa Liew, M.D., Private practice. Epilepsy and sleep.

Completed Program 2005:

• Vitalie Lupu, M.D., Private practice. EMG and neuromuscular disorders.
• Robert Bonwetsch, M.D., Private practice. Epilepsy and sleep.

Electroencephalography and Clinical Neurophysiology
Qualified candidates must complete neurology residency training or the equivalent before entering this program. Program entrance is ordinarily preceded by a one-year Clinical Epilepsy fellowship at NINDS. Candidates must apply at least one year in advance. The expected length of stay is one year, and one position is available each year.

For further information, applicants should contact:

Susumu Sato, M.D.
EEG Section
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Building 10 CRC, Room 7-5680
10 Center Drive MSC 1404
Bethesda, MD 20892
Phone: (301) 496-5121
Fax: (301) 402-8796

Electrodiagnostic Medicine
Qualified candidates must complete neurology residency training or the equivalent before entering this program. One or two positions are available each year, and candidates must apply at least one year in advance. The expected length of stay is two years.

Electronic Application
The quickest and easiest way to find out more about this training program or to apply for consideration is to do it electronically.

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