October 16, 2024 • 42 mins
Dr. Shilpa Reddy is a child neurologist and epileptologist at Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center.
Join me as she shares:
- The process of training a pediatric epileptologist
- Clinical pearls on dealing with childhood epilepsy
- Tips on evaluating episodes that may or may not be seizures
I was fortunate enough to have Dr. Reddy as one of my own instructors during my fellowship training and I'm so grateful that she stopped by to talk with us in this recording!
You can also find her on Twitter/X via the Vanderbilt Pediatric Epilepsy account.
A new podcast from Top Hat delivering ideas, relief, and joy to the future of teaching.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Michael Kentris (00:01):
Hello and welcome back to the
Neurotransmitters.
I am your host, dr MichaelKentris, and we are here to be
your source for everythingrelated to clinical neurology.
I am very happy to introduce,like I always am, one of my
former instructors, dr ShilpaReddy from Vanderbilt University
Medical Center.
But, oh my gosh, I apologize.
What is the name of thechildren's facility on
Vanderbilt University MedicalCenter?
(00:22):
But, oh my gosh, I apologize.
What is the name of thechildren's facility on
Vanderbilt's campus?
Dr. Shilpa Reddy (00:27):
Monroe Carroll Junior Children's Hospital at
Vanderbilt University Medical.
Dr. Michael Kentris (00:31):
Center.
Oh my gosh, there is no way Iwould have remembered that.
I'm so sorry.
No, that's okay.
So I was really happy to hearfrom you and the joke I always
like to make right childneurology it's basically just
neurology, but for smallerpeople, right?
Dr. Shilpa Reddy (00:47):
Funny that you said that, because we have a
lot of and we'll get into thisbut we have adult neurology
residents that train on thepediatric side and pediatric
residents that train on theadult side and we're so used to
people saying aren't kids justlittle adults?
And I had one of the traineestell me aren't adults just big
kids?
Dr. Michael Kentris (00:59):
I think that's probably the more
accurate one.
So what goes so?
First off, let's start withbroad strokes.
For people who may not befamiliar with the specialty, how
does one go about becoming achild neurologist?
And once you are one, what dothey generally do?
Dr. Shilpa Reddy (01:15):
So everyone starts out in medical school.
So you do your four years oftraining in medical school and
when you start thinking aboutwhat specialty you want to do,
I've kind of seen two differenttypes of people that go into
neurology.
Some people really love theactual brain, anatomy,
physiology and they will try todecide between becoming an adult
(01:36):
neurologist or a childneurologist.
But then I've also seen peoplecome at it with their
pediatricians at heart and theyreally love working with kids
and being with kids and so theycome to neurology through the
pediatrics route.
So it doesn't matter, I guess,how you started, but just more
where you end up.
So when you start applying forresidency, if you are on the
adult neurology path, you willapply to a four-year program at
(02:01):
a ACGMA accredited universityand that generally consists of
one year of a internal medicineresidency program and then you
do three years of neurologytraining.
Within that three years ofneurology training you'll spend,
um, I think somewhere aroundsix months doing child neurology
rotations.
And then, on the flip side, ifyou are a pediatric neurology
resident, you apply to afive-year child neurology
(02:23):
residency program and you willdo your first two years being a
general pediatrician under theirtraining program and then your
last three years, similarly, areneurology.
You'll spend kind of dependingon the program, anywhere between
six to 12 months doing adultneurology rotations and the rest
of the time either doing pedsrotations or research or
elective time and things likethat.
(02:45):
So those are the kind of twobig pathways.
And then as a child neurologist, as you're going through your
neurology years, there might bedifferent aspects of the field
that you're more drawn to.
Epilepsy is one of the mostcommon diagnoses, or seizures or
epilepsy are the most commondiagnosis that we see as child
neurologists.
I think the data showssomewhere between like 60 to 70%
(03:06):
of a child neurologist practiceis some sort of seizure
disorder or epilepsy.
So you'll find that people, ifthey're drawn towards epilepsy
and seizures, they can finishtheir five years practice as a
general neurologist and stillhave a big chunk of epilepsy in
their day-to-day practice.
But there are also some peoplethat are super drawn towards
epilepsy and see that passiontowards more complicated forms
(03:31):
of epilepsy and or wanting tolearn more about advanced
management options, whetherthat's the ketogenic diet or
doing surgical things, andyou'll find or, on the flip side
, we'll see people really beinterested in neurocritical care
and it's not that you have todo epilepsy to do neurocritical
care.
But again, we're noticing thatin both adult and pediatric ICUs
(03:53):
there's a high incidence ofseizures, that we are learning
more about detecting and howtreatment affects outcomes.
So I think it is some peoplewill choose to do an epilepsy
fellowship along with theirneurocritical care fellowship to
help kind of round out their um, their training, and so we'll
see people come at it from thatway.
So if you are interested ineither epilepsy surgery or
(04:15):
neurocritical care, you know EEGpeople will do an extra year or
two of fellowship.
If you're not interested inepilepsy or you are more
interested in other things,there's a lot of other diagnoses
in the pediatric neurologyworld, such as demyelinating
disorders, movement disorders,neuromuscular disorders.
We have some people reallyinterested in headaches.
(04:37):
Those are kind of the big oh,and then stroke, of course
pediatric stroke.
So like I said, within childneurology you're probably going
to see epilepsy and seizures ona day-to-day.
But if you're more interestedin a specific aspect it's kind
of nice to know you can dofellowships that usually last
about a year after the fiveyears of training.
Dr. Michael Kentris (04:57):
Excellent.
Now, obviously I'm biased.
So I did my likeneurophysiology slash epilepsy
training at Vanderbilt and I wasvery fortunate to spend about a
month or so on the childepilepsy service.
And I had this one distinctmemory in particular.
It was like the first.
It was one of the first days Iwas on service and I think it
(05:19):
was Dr Patterson perhaps I mightbe getting the name wrong.
I apologize, dr Patterson,perhaps I might be getting the
name wrong.
I apologize, but it was a childwho had a history of
Lennox-Gastaut syndrome and Iwas looking through it and I was
like, oh, there's a lot ofepileptiform discharges.
The EEG is pretty abnormal, butI didn't see any seizures.
And she's like, oh, are yousure?
And she's like, well, whatabout this?
And there was like the littleflattening there, sort of the
(05:43):
electro decadental response, ifyou will, and it's like, oh,
each one of these like five perpage is a seizure.
Dr. Shilpa Reddy (05:50):
And yeah, and she, I remember just saying
we're still like, don't worry,all of our adult fellows missed
that initially I mean it's sofunny that just you just said
that, because the fellowyesterday reminded me on her for
adult fellow on her first monthof peds there was two back back
to back EGs where there wasmultiple spasms on the EGs and
she's like I didn't see those.
But I always say you know,that's why you're here, that's
(06:11):
why you're in training.
Dr. Michael Kentris (06:13):
Right.
And now here I am, God, sevenyears later, and I still have
that core memory with me.
Dr. Shilpa Reddy (06:20):
Yes, I mean this is a little editorial, but
I do feel like, by quote unquote, missing things or getting
something wrong, you know, in asituation where you have support
, is the best way to learn,because as high achieving people
(06:45):
as we are, you're going toremember a time that you felt
embarrassed or a time where youdidn't have that knowledge or
you know so, at least for me.
Dr. Michael Kentris (06:49):
I think that's an interesting way to
learn, yes, that kind ofemotional tag to the learning
experience.
Now, as you mentioned, right,you are one of these people who
is more engaged with seizuresand epilepsy, in fact
instructing more juniorphysicians in becoming better at
it.
But just like with adultneurologists, we know child
neurologists are kind of at apremium across the country.
(07:09):
There's definitely not enoughpeople with the expertise kind
of scattered, especiallyuniformly across the country.
So it's not unusual, right.
People have unusual spells orepisodes, and if we were to talk
to the family medicine doctorsor the pediatricians out there
who are providing most of thiscare, this primary care, what
(07:29):
are the things that you wouldsay they should look out for?
That might warrant moreinvestigation.
Dr. Shilpa Reddy (07:35):
Yeah, I love this question because, as you
mentioned, neurologists bothadult and child neurologists are
a limited resource in ourcountry and we know that care is
not evenly distributed indifferent parts of our country.
So I think the more that we canempower providers in other
areas besides our academiccenters that are in bigger
(07:57):
cities, then I think we're goingto do justice for our patients.
So whether that means trying toagain educate the primary care
providers about how to treatcertain conditions, but mostly
education about when to refer tolike a bigger epilepsy center
for care, I don't want patientsto miss out on opportunities for
surgical management, you know,because other providers are
(08:27):
trying five, six, sevenmedications before thinking
about surgery.
And both in the adult andpediatric populations we know
that early surgery leads toimproved outcomes.
So more than ever we want to beable to streamline the
referrals and the workup and, ofcourse, the treatment that kind
of starts in the beginning, soI can speak mostly for pediatric
(08:49):
patients and that streamlinejust because I don't see adult
patients.
But you know we try to docontinuing medical education
seminars for generalpediatricians in our community
and the focus is on, again,seizures being a big part of
child neurology.
We focus on how to identifyseizures and seizure safety,
(09:11):
things like that.
So for our generalpediatricians, I think knowing
that seizures can manifest a lotof different ways clinically,
that kind of opens the door.
So if a patient comes in withweird behavior, weird episodes,
we really should be diggingdeeper into like okay, tell me
more about this episode so I canput them in a bucket of this is
(09:32):
seizure, this is not seizure.
And I start with really askingas many details as possible.
So, starting at the beginning,what were you doing when this
episode happened?
Then, what did you feel?
Then what did you feel?
And then, if there's a witnessor a bystander, kind of asking
the family or sibling saying,well, what did they do next?
What did they do next?
And then what happened at theend of that episode and it's
(09:54):
also important to interject andsay to the patient how much of
this did you remember, did youblack out?
Because that can help kind ofput us in one category or the
other.
And then going beyond that andsaying how, how many times did
it happen?
Um, how long does it last?
Um cause, like I said, thereare a lot of things that look
like seizures that aren'tseizures, but then there's also
(10:16):
some strange episodes that endup being seizures.
So, just kind of getting asmuch detail as possible so that
if you are able to connect witha neurologist at some point, you
can give them as much as astory.
Nowadays we have cell phones atour disposal, so we often ask
family members, or even teachers, if it's a younger kid, to take
videos with parents permission,because we always say, like
(10:37):
pictures are worth 1000 words,but videos are even better, it's
so true.
We, as humans, like to say weremember every single detail
about things.
In the moment of stress orpanic and, to your point,
getting emotion into it can canalter the way that we describe
things or remember things.
So videos are great absolutelyso I think the big things that a
(10:57):
pediatrician can can be lookingout for is is there sort of a
loss of consciousness or alteredawareness during the episode?
So we encourage family membersto ask them to do commands or
have them talk to them during it.
We look out for things that arevery stereotyped, meaning, does
the episode happen the same wayevery single time?
Yeah, and then beyond that, youknow, I don't know how much
detail we want to hear, but,like I said, different types of
(11:20):
seizures can manifest differentways.
So one of the most common onesthat we think about are absence
seizures, and it can really goboth ways.
So we see a lot, a lot, a lotof referrals for kids that stare
off or zone out, and it'sreally tempting for everyone to
say this is an absence seizurebecause they're staring, and
this is the type of seizure weknow is associated with staring.
(11:41):
So what I would say is it'sreally important to test
responsiveness in these patients.
And even though off-senseseizures classically are very,
very short, the zoning out orthe staring off is unresponsive.
So if you were to touch thepatient's face or give them a
little pinch, tickle them, theyshouldn't be able to respond or
break out of their episode,whereas kids that zone out or
space out, if you startle themin some way they might not
(12:04):
respond verbally but they'll atleast either shake their head or
blink or kind of tend towardsyou.
So that's an important feature.
And then for obstinate seizures, I think something to remember
is some kids can have some motormanifestations where they
flutter their eyelids, mighthave a little bit of lip
smacking, potentially evensomething with their hand.
So that might distinguish thattoo.
(12:31):
So the tricky part is ADHD is avery, very common diagnosis in
kids and it usually starts beingclear around that school age
five, six, seven years old,which also is the age where
absence seizures tend to be.
You know the onset.
So it can be very difficult totease out the ADHD staring and
attention from absence seizures,especially because we know kids
with absence epilepsy have, themore commonly have ADHD or
(12:52):
higher incidence of ADHD.
So if I can take a detour here,so there is an app that's being
developed, which I think kindof goes.
I'm sure you've talked about AIand things on your podcast, but
there's a lot of healthcaretechnology that we can start
incorporating to our practiceand I'm like super excited about
some of it being able to reachmore people or being able to
diagnose earlier.
I think that's great.
(13:13):
So this app is ahyperventilation app.
With obstinate seizures theytend to be induced by hyper
ventilation, but we often likeit's hard for kids to
participate in that type ofthing, especially if we're not
right there coaching themthrough it.
So the app basically coachesthe kid to hyperventilate using
some fun I don't know techniques, and then there's a little
(13:33):
camera that looks at the kid'sface and they can, I think uses
an algorithm to track if theyhave like eyelid fluttering or
if they have pauses in theirbreathing, for how long they
have like eyelid fluttering orif they have pauses in their
breathing for how long, and thenit'll be sent to somewhere
where the neurologist can reviewit.
Or there's like an algorithmthat reviews it and then it
spits out a report saying, hey,this kid had three they can't
(13:54):
call them seizures, but likethree episodes where there was
behavioral arrest or eyelidfluttering and then the
neurologist can look at it, oreven a pediatrician if they have
this app in their office, theycan look at it and be like, oh
well, this looks concerning, letme send them to the neurologist
, if that makes sense, and Ithink it's a nice way you can
use it twofold.
One is pediatricians can helptriage their referrals for
staring.
(14:14):
If it doesn't show up asanything, maybe they go down the
ADHD path or they can see theneurologist in a couple months.
But if the report spits out andsays, hey, there's three
episodes that sound concerningfor seizures, they can call the
neurologist and say I need thiskid seen for an EEG, like in the
next couple of weeks, you know.
And then neurologists can useit, because if we have a kid
that has absence seizures, thenwe're starting medication and we
(14:36):
want to monitor the response totreatment.
We can have the family do thisat home and say, okay, well, we
still had episodes like maybe weneed to up the medicine, I
don't want to wait the sixmonths before my return
appointment.
So I think it's exciting and Ihope that it starts being
incorporated into practice inthe future.
Dr. Michael Kentris (14:54):
No, that's really neat.
That's not something I wouldhave thought about because I
also get many consults in theadult world for staring spells,
slash absence, seizures and Ihave to say, no, that's for
children.
Dr. Shilpa Reddy (15:08):
Yes, and even so, like I would say, a large
portion of our patients in ourpediatric epilepsy monitoring
unit come in for staring spellsthat end up not being seizures
because kids, like I said, theyzone out, they have an attention
.
It's just a common thing.
Dr. Michael Kentris (15:24):
Right, yeah , I know, in the adult world,
you know, nearly half also endup being non-epileptic.
So it's one of those thingsthat when you go into the field
you're like, oh, I thought I wascoming here to take care of
epilepsy and seizures.
It's like, well, there's a lotof other things that are in the
kind of the orbit of thosediagnoses that you end up being
(15:44):
the person best equipped to tohandle a hundred percent I was
just gonna say, sometimes I feellike more, like, like more than
an epilepsy specialist.
Dr. Shilpa Reddy (15:53):
You're kind of like a spell specialist yes,
that's a good way of saying that.
Well, so in that same vein,there's a lot of things that can
look like seizures.
Syncope is one of those that'sfairly common in kids and not
dangerous per se.
Psychogenic non-epilepticspells I'm sure you've had like
a podcast on that.
(16:15):
I think that's super importantto talk about.
But just understanding thesequence of events and the
responsiveness of a patient canhelp any provider really think
about is this in the category ofnon-epileptic or the category
of seizures?
So yeah, a lot of differentinteresting episodes, but videos
have been great.
I I again with family'spermission I've had
(16:36):
communications and relationshipswith pediatricians where if
they can just send me a video, Ican triage that pretty quickly
rather than, oh, putting it inthe queue to like, maybe I'll
see you in six months when wefinally have an opening.
Dr. Michael Kentris (16:51):
No, absolutely.
Yeah, Triageing is so importantand, as you said, the video,
not always but very often, canprovide such good insights to
someone who knows what to lookfor.
The semiology is what we in thebiz call it, but basically just
like the clinicalmanifestations of the event, and
it's one of those things where,you know, I consider in
(17:13):
neurology, like the movementdisorder specialist, to be kind
of like the grandmasters of this, but I feel like we're maybe,
you know, second place in termsof like looking at an event,
what's happening.
You know, it's the story of thespread of an event, or of a
non-epileptic event as well, andit's one of those things where
(17:35):
I really appreciated my trainingat Vanderbilt, where I kind of
think of it as like the athleteswho had run tape after after a
game and they're watching.
You know it's like like well,did you notice this?
No, it's like all right, let'sgo back again and we'll watch it
again.
And you just do it over and overagain for hours every week and
it really just drills into you.
You know, making sure that themind recognizes what the eyes
(17:57):
are seeing, if you will, andit's kind of one of those weird
skills that you don't reallythink about but like becoming a
trained observer of a phenomenon.
Dr. Shilpa Reddy (18:05):
Yes, yeah, we have the.
You know, we're fortunate tohave a lot of practice, like you
said.
I mean, there's been studiesthat show like different levels.
So, if you're a patient versusprovider, versus family member
and like that, are you aneurologist, are you
epileptologist?
And the accuracy of detecting anon-epileptic spell versus a
seizure, um, it gets a littlebit better and better as, like,
(18:27):
the more training that you have.
But we're honestly like, we'regood but we're not.
We're not perfect by any means.
Dr. Michael Kentris (18:31):
no, no but it's interesting I have been
fooled uh, more times than Icare to think about.
Dr. Shilpa Reddy (18:37):
I think I was fooled today.
Dr. Michael Kentris (18:41):
Every day is a new opportunity.
Dr. Shilpa Reddy (18:43):
Yes, for learning yes.
Dr. Michael Kentris (18:47):
So so you know you are in an instructor
role and, as you mentionedearlier, there are certain kinds
of people who are maybeattracted to the specialty.
But what kind of skills doessomeone accrue in particular in
a child epilepsy trainingprogram or just a general more
(19:08):
neurophysiology epilepsytraining program that might give
them a leg up in these kinds ofparticular patient populations?
That?
Dr. Shilpa Reddy (19:16):
might give them a leg up in these kinds of
particular patient populations.
I really love this questionbecause I've been asked this a
few times as fellows or, excuseme, applicants have been
applying to our fellowshipprogram this year and they
always ask what are you lookingfor in a fellow?
I was like, okay, let me tellyou, michael Kendrick Only half
joking, but really honestly, asan epileptologist, I think you
(19:36):
hinted at this you really needto be detail oriented.
So, although, in order totriage patients to our clinic,
we want to get kind of a bigpicture of what the story is and
what the what these episodeslook like, the semiology, what
we are looking for when we'reanalyzing seizures is like the
nitty gritty of okay, did theirface turn this way for one
second before their eyes went?
(19:56):
Was it their left hand that wasdoing a dystonic movement
versus a rhythmic movement,versus you know so there's so
many details that help uspinpoint exactly where the
seizures are coming from, whichis going to be really important
to if we wanted to do surgeryand take that area out.
That is like the first step.
So very, very important to bedetail oriented.
You know that even drills downto when we're reading the EEG.
(20:20):
Let's say it's not epilepsysurgery, it's an ICU patient
being able to describe thewaveforms in a way that if I
sent this report to you, michael, you would be able to draw this
out.
I think Dr Pagano maybe toldyou that too.
You should be writing a reportwhere I could take it and draw
the EEG and it looks exactlylike the one that's running.
So I think that's a very goodskill set to have.
(20:43):
I think as an epileptologist,you really need to be curious.
I think in every field there'sso much more to learn.
But I can only speak toepilepsy, and I think there's so
much more to dive into.
I talked about kind of thehealth tech part of things, but
there's also more to dive intoin regard to surgical devices
(21:04):
that are being implanted and howwe're actually looking to cure
epilepsy rather than treatepilepsy.
So having that intellectualcuriosity is super, super
important.
And then I think this is generic, but I, I guess I I want people
that are interested in learningand I don't know if that's the
same as being curious, but Iwant them to be engaged.
(21:25):
I never want to take anythingfor face value, I guess.
So if you're an epileptologist,you're always thinking about
what else could this be and whatelse can I do for my patient.
I think we do everybody adisservice if we just say, okay,
return patient on your meds,they're happy, let's go bye.
I think there's alwayssomething to be not actually
(21:47):
changed, but something to talkabout and discuss and make sure
that you're engaging with thepatient for more than just their
seizures.
Are we talking about quality oflife and mood, their social
situation?
Because, again, you can have awhole podcast about living with
epilepsy and what that means atdifferent stages of life.
So I think that is kind of whatI mean by pushing a little bit
(22:09):
deeper with learning andcuriosity.
Dr. Michael Kentris (22:12):
Yeah, no, I think I'm sure that you've seen
some of these lectures of theyear with Dr Ben Bades.
I might.
I think, um, I sure, I I'm surethat you've seen some of these
lectures of the year with uh DrBen bodies I might be
mispronouncing his name from uhfrom Florida, but he's, he's
always.
You know, maybe you get thatreferral and you know you've got
an EEG report that shows, youknow, sharp waves in this, that
or the other area.
And you know, there there is asometimes a bit of skepticism.
(22:35):
Right, you have to trust, butverify if you will.
And so I know we certainly seethat same thing on the
neuromuscular EMG side of thingsand I would say at least to the
same extent on the epilepsyside of things, where you know
it really becomes a question oflike, do I know this person and
do I trust their clinicaljudgment as well?
(22:57):
And I know that sounds like abit of a hard nose take.
But if you just, as you said,accept it on face value, more
often than not you end upgetting burned a little bit.
Dr. Shilpa Reddy (23:10):
Yeah, that is a very good conversation.
I had it with one of ourfellows multiple times this year
.
I like to trust but verify.
I think that I think that's agreat outlook on life and I
think it's a very nice way ofsaying that.
Dr. Michael Kentris (23:25):
It's probably the nicest way I can
say it.
Dr. Shilpa Reddy (23:26):
Yes, yes, I mean just to be completely
transparent.
I mean there are patients whereI will read the patient in
August and I'll say I think thisis a arousal pattern from sleep
, that's totally normal.
And then we read it again sixmonths later, like me, the same
me, and I say oh no, this is,this is definitely a frontal
(23:46):
lobe seizure.
So that's happened a few timesin my career and I would be
surprised I mean, I'm sure ithappens to everybody.
So I think it's okay.
Dr. Michael Kentris (23:54):
It's okay to look at things with a
different lens, whether it's youor one of your colleagues or
another institution, you know ifyou'll indulge me, but the
phenomenon we call over-readingor under-reading EEGs, that is,
(24:20):
say, calling something abnormalwhen it's normal versus calling
something normal when it'sabnormal.
And I think we all go throughphases At least when I've worked
with residents in the past, thefirst couple of months they
miss everything.
They don't pick up on anyabnormalities whatsoever.
And then, after they've done afew months of reading EEG, then
everything's abnormal, like isthis a central spike?
(24:43):
No, that's a vertex wave andall these things right.
You kind of go through thesewaxing and waning phases where
you're under-calling,over-calling, you just bounce
back and forth through theextremes until hopefully, you
wind up somewhere in the middle.
But there are still those caseswhere you're just like ah, I
don't know, this one's a little,it's a little funny looking,
(25:05):
but I don't have enough data tosay like, does this correlate
with every episode?
The person has Right and toyour point, you know, you maybe
you get that second study andnow you have this and you're
comparing it to your past oneand it's like well, this changes
the entire lens that I waslooking at it through.
So it's not necessarily thatit's now abnormal as much as
like putting these two piecestogether gives you like a bigger
picture of the whole.
Dr. Shilpa Reddy (25:26):
No, I love that and I think that's I mean,
there's so many pearls to besaid in this one is.
You know, I think I'm known asa master hedger in EEG reports
because I don't like committingto something.
If I myself have a little bitof doubt, I don't want to put it
down there that, like, I'm 100%sure that this is, like you
said, abnormal or normal.
So I think it's better to talkabout it because you need the
(25:47):
clinical context and sometimestime Things declare themselves
right.
Dr. Michael Kentris (25:51):
Absolutely.
Dr. Shilpa Reddy (25:53):
And then the last thing you mentioned about.
Dr. Michael Kentris (25:54):
you said Getting the pictures in time.
Dr. Shilpa Reddy (25:58):
Yeah, I think that is the hard and nice thing
about reading EEGs because Iwill say I've been on both sides
where I read my own EEGs forpatients that I see on the
inpatient, outpatient side.
But there's a lot of timeswhere I read studies for my
colleagues who arenon-epileptologists on the
inpatient service and so it'stempting to like want to change
(26:19):
my read because of somethingthey said in their notes but
without seeing the patient.
You know, I think I try to beas quote unquote clean as
possible in my EG reads, if thatmakes sense you want to be as
effective as possible, becauseyou want your data that you're
adding to your clinical picture.
(26:41):
Each data point should beobjective, so that when you put
it together, then it's your turnto interpret.
Dr. Michael Kentris (26:46):
Right, and it's funny you mentioned that.
So after I graduated fellowship, I was at an academic
institution for a few years andI remember one of the chief
residents at the time said youneed to change the way that you
write some of your impressions,because the hospitalists don't
know what you mean, so they'reconsulting us on this basically
(27:09):
normal report.
And I was like, oh, and so thatis right, you have to keep your
audience in mind.
Who is going to be reading this?
I know that's one of the thingsthat they emphasize a lot, and
so I actually ended up shiftingaround so that, like, the most
generic aspect was at the top,so that if you wanted to get
into all the nitty grittydetails you had to scroll past
(27:30):
the actual impression, which Ithink stopped a lot of those
consults.
But but it was this thing whereit's just like, oh, this is just
the way I, I've been doing itand it's not working in this
environment.
So I had to change.
You know a little bit of how Iput the pieces together.
You know, change the verbiageslightly, right, there's a lot
(27:50):
of synonyms that we use, likeepileptogenicity versus you know
, uh, various other things, orseizure potentials, etc.
Etc.
And uh, know your audience Iguess, is.
The is the main takeaway forpeople who are writing reports,
whether it's eegs or anythingelse yeah, even when we get mri
reports from neuroradiologists,like they all you know.
Dr. Shilpa Reddy (28:12):
I think the point is you have clinical
context is important or clinicalcorrelations recommended.
Dr. Michael Kentris (28:17):
Absolutely.
Dr. Shilpa Reddy (28:19):
And I find it interesting with trainees in
general.
I think the point of doing moretraining is for you to know
what you don't know, and I think, as a trainee, it's just
natural for us to say, well, Ineed to know this, I need to
know this, I need to know this.
But, as an attending, thefurther that you step out, it's
(28:39):
really easy for me to say, hey,I need to know this, I need to
know this, I need to know this.
But, as an attending, thefurther that you step out, it's
really easy for me to say, hey,I don't know that and that's
okay, whereas, like you don'tknow that point, when you're a
trainee, you know everything but, as you mentioned, like we're
humbled a lot of times by, bynew information and you know
things don't fit in a box alwaysI know it feels like every time
I'm asked a question anymorethese days I have to start with
well, it depends.
Dr. Michael Kentris (29:01):
I can't just give an answer anymore.
Dr. Shilpa Reddy (29:02):
I've reached that stage in my career I know I
think I got feedback um acouple years ago from the
residents and they're like youknow, dr, ready doesn't like
commit and I'm like it's reallyhard, like when I don't have
data, to say, yeah, 100 rightthing to do yeah, but that that
really, I mean that's, that'smedicine, right, it's just, uh,
the the practice of medicine.
Dr. Michael Kentris (29:23):
It's because, yes, we have all these
big highfalutin studies, butwhen you try and break them down
to an individual, sometimes itdoesn't always work the best yes
, I totally agree so you knowwe've we've talked a little bit
about kind of like eeg trainingyes, I totally agree is when we
have these kids who grow up andthey start to age out of the
(29:45):
child neurology clinics.
And obviously a lot of kids withepilepsy they do grow up, they
reach adulthood and then theyhave to eventually find an adult
(30:08):
neurologist, which, let's justsay, I'm aware that there is an
ethos difference in terms of theamount of, let's just say,
white glove service that cansometimes be found.
And what do you find are themost helpful things If you're
going to say, talking to afamily or even to an adult
(30:28):
neurologist who's getting one ofthese people you know, children
with epilepsy who are kind oflike hitting the 18, you know
plus mark, and they're coming toyour clinic.
What are the considerations,especially for the more, let's
just say, not straightforward,you know, not like juvenile
myoclonic epilepsy, people withintellectual disability, etc.
Dr. Shilpa Reddy (30:46):
And we know that based on you know, studies,
papers, literature that's comeout that that transition between
pediatric and adult formedically complex patients not
just epilepsy, but you know, inall realms is super, super
important.
And when it's not done well, wesee a lot of patients lost to
follow-up, we see more ER visits, we see more just like
(31:07):
healthcare expenses, all thatdepression, quality of life
suffers.
So one I'm really glad you'reasking that question because we
need to have awareness that thisis a problem not just here
across the world, but there aresome clinics and institutions
that are doing a really good jobwith the institution, with
transition clinics.
And what a transition clinicincludes is obviously that
(31:32):
support from the adultneurologist or evolutologist as
well as the pediatric side, butit also that support from the
adult neurologist or optologistas well as the pediatric side,
but it also gives support from,like, a social work perspective
or case management, somebodythat is there to figure out.
Okay, how do I make thatinsurance transition, as some of
these kids, most of these kidshave conservatorship um, from
their parents.
They need adult, you knowguardians to take care of them.
(31:52):
They don don't havedecision-making capabilities,
and then also a psychologist,because there's a lot of
probably emotional stress andtrauma from the caregiver side
and, if the patient is awareenough, that might be hard for
the patient as well.
So, having multidisciplinarysupport when you make that
transition, it's also kind of aphysical challenge to get all
(32:15):
these people in one space.
It's also, just to be totallyfrank, there's going to be
billing and financial issuesthat come from sharing the
resources, so to speak.
So, as much as I say it'sreally, really important to do
this.
It's not that easy to actuallyexecute, but the first step is
talking about it.
So I'm glad you brought it up.
(32:38):
And what I do personally is Istart prepping patients when
they are 15, 16 years old andstart saying like, okay, you
know, as you get to that 18, 19,20 years old, we need to start
thinking about one.
What does life look like?
So?
Are they independent?
Are they going to go to college?
How are you going to learn totake your meds and get follow-up
appointments?
Are you going to be safe withsleeping, safe with alcohol and
(33:02):
drug exposure, sleep deprivationAll these things are super
important when you're not livingunder the roof of adults that
are telling you what to do.
And then, for patients that arenot independent in terms of
daily activities, what does lifelook like for the caregivers?
You know they're not going tobe in school every day, so are
they going to be in a group home?
Are they going to be in a likea work program?
You know things like that.
(33:22):
So I start asking thosequestions around, like, like I
said, 16 ish.
And then, when they're 17, 18,and they cross that technically
being an adult age, I alwaysgive one or two visits of okay.
At the next visit we're goingto try to identify somebody that
you want to see in adultneurology, whether that's in the
same institution or findingsomebody closer to home.
(33:43):
So at least it gets themthinking, without dropping the
surprise on them and saying okay, you're 18, bye, because that
can lead to a lot of emotionalstress and like tension and, as
you kind of hinted at some ofthese families, because they've
had epilepsy for a very longtime, they become attached to
that specific provider.
And so it's a relation, it'shard to say goodbye on both
(34:06):
sides, like for us and for them.
So I think just trying to likebring it up slowly and gently at
a few different points Good.
I always find that if I find,if I can refer to a provider
that I can what's the word, um,that I, yeah, vouch for exactly
that I know personally then Ican say, oh, you should see, dr,
(34:26):
so-and-so, they're going to bereally great with your daughter
or your son because they're kindor they're funny or they're
super smart or they're gentle,like whatever it is that I think
that patient needs is.
While I'll try to, I'll try tolike connect them with a
provider that's going to be agood fit.
Does that make sense?
Dr. Michael Kentris (34:43):
Yeah, a personal recommendation.
Dr. Shilpa Reddy (34:45):
Yeah.
No, that's excellent,everybody's for everybody, you
know we all have different.
Dr. Michael Kentris (34:49):
This is very true.
Dr. Shilpa Reddy (34:57):
And then I guess I do want to hint on this
because we're kind of tyingtogether education People always
ask when they're applying forthis fellowship, like I'm a
pediatric neurologist orpediatric epileptologist, how do
I run the adult and pediatricepilepsy program?
Because I kind of live in bothworlds and I always say, like
epilepsy is a lifelong journey,it's a lifelong story.
So if you see a patient that's35 and they have temporal lobe
epilepsy from like a structuralcause or maybe even not a
(35:19):
structural cause, more thanlikely they probably started
having seizures when they wereyounger, maybe a teenager or a
kid, when they had febrileseizures.
So you need to understand theirjourney of how they got there.
On our side, as a pediatrician,I need to understand that when
I have a five, six, seven,eight-year-old that has
intractable epilepsy, I want tobe able to treat that now so
(35:39):
that when they are 35, what doestheir life look like if they
continue to have epilepsy, withthis frequent of seizures?
Or can we do something now?
Or let's say you are trying tocounsel a 17-year-old about a
new diagnosis.
Are they going to outgrow thisin two years, five years, ten
years?
If I don't understand the lifecycle of a particular diagnosis.
(36:00):
I can't tell them like, oh, youcan have kids or you're never
going to work.
I need to understand it right.
So when we train both adult andpediatric neurologists,
epileptologists, they getexposure in both worlds, both
adult and pediatric neurologists, epileptologists.
They get exposure in bothworlds, not so much that they're
going to be seeing thesepatients every day, but just
understanding where they camefrom or where they're going.
Dr. Michael Kentris (36:21):
Right, getting the big picture.
To be honest, I have found thatsuper helpful in my own
practice as well.
We don't have as muchgeneralized epilepsy or
epileptic encephalopathies inthe adult population, but you
(36:45):
know it's not unheard of that weget.
You know someone in their 40sor 50s who has Lennox-Gastaut.
You know went through the wholecycle with West syndrome when
they were younger, etc.
And so they come in on, youknow, a fairly complicated
regimen of anti-seizuremedications which can be a
little intimidating if you'reunfamiliar with all the
interactions and the levels andall the pharmacology in play.
So I would say there's the wholespectrum the diagnostic aspects
, with reading the EEGs andbeing familiar with what all the
(37:07):
squiggly lines mean, and thenknowing the existence of the
syndromes and then knowing thepharmacology for the treatments
and then the surgical treatmentsthat we, you know we didn't hit
on a lot.
Just that's an entireconversation too.
But what are the options?
Right?
And I think this is just thetip of the iceberg.
We're talking just aboutpediatric epilepsy, but this
(37:28):
applies to all thesubspecialties within neurology.
There are all of these thingsbeyond even what we know, that
all of these, our subspecialtycolleagues in each of these
fields are experts within, andit is one of those things where
medicine at large and neurologyand then each subspecialty of
neurology is expanding at such arapid rate it's nigh impossible
(37:52):
to keep up on the latestadvances in every field.
It's a very Herculean task.
Dr. Shilpa Reddy (37:58):
Absolutely.
It kind of takes me back to oneof my first rotations as a
medical student.
I was on a rotation and theclerkship director said the
biggest mistake you can make asa doctor is not asking for help
when you need it.
And I think that kind oftouches on what you're saying is
if I don't know thesesubspecialties exist, if I don't
know this treatment exists, Idon't have to be able to do it.
(38:19):
I just need to know that I needto call somebody else.
Dr. Michael Kentris (38:23):
Right, yeah , and I think that's that's one
of the things I love the mostabout about the neurology
community is that everyone is sowelcoming.
And you know, it's so great tobe able to reach out to people
who helped me become theneurologist I am and, uh, other
people who I've interacted withover the years or who I've even
helped train early in theresidency and then they went on
(38:45):
and did different specialty.
I can call up my formerresidents and ask them like, hey
, you're a neuromuscular guy now.
Uh, what do you think aboutthis?
Does this sound like something?
And I get advice myself.
Yes, so it's very good to havethis network, this community of
people that you can, like I said, you can trust who's a clinical
(39:06):
acumen that you helped form,you've seen in action.
You know these people arereliable.
It's such an invaluableresource.
It's just being able to reachout to people and ask their
opinions.
Dr. Shilpa Reddy (39:19):
I couldn't agree more.
Dr. Michael Kentris (39:20):
Any final thoughts that you would have for
people who might be maybeconsidering child neurology or
even pediatric epilepsy as afuture specialty?
Dr. Shilpa Reddy (39:31):
I would say for child neurology, just know
that there's a lot of differentoptions and spaces that you can
be in, even after doingresidency training, and the same
goes for being a pediatricepileptologist.
We train two different types ofepileptologists.
One is they want to do surgicalepilepsy stereo EEG device,
implants, all that kind of stuffand then we also train equally
(39:54):
as many people that go into apractice where they are not
doing surgery and they're not ata level four epilepsy center
but they are providing reallygood care for their patients
because they know, of course youknow, like, how to read their
EGs and interpret them, but theyknow when to refer for surgical
management.
And I think we need just morechild neurologists, more
(40:16):
epilogue psychologists, we needmore of everybody so that we can
reach as many patients aspossible.
Dr. Michael Kentris (40:22):
Absolutely.
If people want to find out moreabout your work or your work at
Vanderbilt, where should theylook?
Should they track you downonline?
How would you recommend gettingin touch?
Dr. Shilpa Reddy (40:32):
Don't come to my house.
Should they track you downonline, how would you recommend
getting in touch?
Don't come to my house.
Dr. Michael Kentris (40:39):
But so we have.
We have a ex, the old Twitteraccount, yes, formerly known as
Twitter yes, Formerly known asTwitter.
Dr. Shilpa Reddy (40:44):
It's at V-U-M-C, p-e-d, e-p-i-l-e-p-s-y,
at V-U-M-C.
Peedepilepsy is our handle.
I'm the one that runs theaccount, so feel free to reach
out to me or DM me.
That way, you know our our.
We have a website for thefellowship pages at Vanderbilt
(41:05):
on the neurology website yeah,that sounds great.
I was like I don't know the linkor anything, but I think if you
are, if you're specificallyinterested in, you know, coming
to vanderbilt, just likelearning about what I do, then I
think dming me on x uh wouldprobably be the I know it just
doesn't sound right in the mouth, does it?
(41:25):
yeah, it doesn't, it doesn'troll off the tongue, but, um,
yeah, I think I've connectedwith a few people that way and I
think it's nice to kind ofstart the dialogue and then we
can email or chat on the phone,whatever people are interested
in.
Dr. Michael Kentris (41:38):
Awesome.
Thank you so much.
You can also find me on X I'mat Dr Kentris D-R-K-E-N-T-R-I-S,
or you can follow theNeurotransmitters at neuro
underscore podcast and check outour stuff on the website at the
neurotransmitterscom.
Dr Reddy, thank you again.
I really appreciate you takingthe time to talk with us today.
Dr. Shilpa Reddy (42:01):
Thank you, Michael.
Hello and welcome back to the
Neurotransmitters.
I am your host, dr MichaelKentris, and we are here to be
your source for everythingrelated to clinical neurology.
I am very happy to introduce,like I always am, one of my
former instructors, dr ShilpaReddy from Vanderbilt University
Medical Center.
But, oh my gosh, I apologize.
What is the name of thechildren's facility on
Vanderbilt University MedicalCenter?
(00:22):
But, oh my gosh, I apologize.
What is the name of thechildren's facility on
Vanderbilt's campus?
Dr. Shilpa Reddy (00:27):
Monroe Carroll Junior Children's Hospital at
Vanderbilt University Medical.
Dr. Michael Kentris (00:31):
Center.
Oh my gosh, there is no way Iwould have remembered that.
I'm so sorry.
No, that's okay.
So I was really happy to hearfrom you and the joke I always
like to make right childneurology it's basically just
neurology, but for smallerpeople, right?
Dr. Shilpa Reddy (00:47):
Funny that you said that, because we have a
lot of and we'll get into thisbut we have adult neurology
residents that train on thepediatric side and pediatric
residents that train on theadult side and we're so used to
people saying aren't kids justlittle adults?
And I had one of the traineestell me aren't adults just big
kids?
Dr. Michael Kentris (00:59):
I think that's probably the more
accurate one.
So what goes so?
First off, let's start withbroad strokes.
For people who may not befamiliar with the specialty, how
does one go about becoming achild neurologist?
And once you are one, what dothey generally do?
Dr. Shilpa Reddy (01:15):
So everyone starts out in medical school.
So you do your four years oftraining in medical school and
when you start thinking aboutwhat specialty you want to do,
I've kind of seen two differenttypes of people that go into
neurology.
Some people really love theactual brain, anatomy,
physiology and they will try todecide between becoming an adult
(01:36):
neurologist or a childneurologist.
But then I've also seen peoplecome at it with their
pediatricians at heart and theyreally love working with kids
and being with kids and so theycome to neurology through the
pediatrics route.
So it doesn't matter, I guess,how you started, but just more
where you end up.
So when you start applying forresidency, if you are on the
adult neurology path, you willapply to a four-year program at
(02:01):
a ACGMA accredited universityand that generally consists of
one year of a internal medicineresidency program and then you
do three years of neurologytraining.
Within that three years ofneurology training you'll spend,
um, I think somewhere aroundsix months doing child neurology
rotations.
And then, on the flip side, ifyou are a pediatric neurology
resident, you apply to afive-year child neurology
(02:23):
residency program and you willdo your first two years being a
general pediatrician under theirtraining program and then your
last three years, similarly, areneurology.
You'll spend kind of dependingon the program, anywhere between
six to 12 months doing adultneurology rotations and the rest
of the time either doing pedsrotations or research or
elective time and things likethat.
(02:45):
So those are the kind of twobig pathways.
And then as a child neurologist, as you're going through your
neurology years, there might bedifferent aspects of the field
that you're more drawn to.
Epilepsy is one of the mostcommon diagnoses, or seizures or
epilepsy are the most commondiagnosis that we see as child
neurologists.
I think the data showssomewhere between like 60 to 70%
(03:06):
of a child neurologist practiceis some sort of seizure
disorder or epilepsy.
So you'll find that people, ifthey're drawn towards epilepsy
and seizures, they can finishtheir five years practice as a
general neurologist and stillhave a big chunk of epilepsy in
their day-to-day practice.
But there are also some peoplethat are super drawn towards
epilepsy and see that passiontowards more complicated forms
(03:31):
of epilepsy and or wanting tolearn more about advanced
management options, whetherthat's the ketogenic diet or
doing surgical things, andyou'll find or, on the flip side
, we'll see people really beinterested in neurocritical care
and it's not that you have todo epilepsy to do neurocritical
care.
But again, we're noticing thatin both adult and pediatric ICUs
(03:53):
there's a high incidence ofseizures, that we are learning
more about detecting and howtreatment affects outcomes.
So I think it is some peoplewill choose to do an epilepsy
fellowship along with theirneurocritical care fellowship to
help kind of round out their um, their training, and so we'll
see people come at it from thatway.
So if you are interested ineither epilepsy surgery or
(04:15):
neurocritical care, you know EEGpeople will do an extra year or
two of fellowship.
If you're not interested inepilepsy or you are more
interested in other things,there's a lot of other diagnoses
in the pediatric neurologyworld, such as demyelinating
disorders, movement disorders,neuromuscular disorders.
We have some people reallyinterested in headaches.
(04:37):
Those are kind of the big oh,and then stroke, of course
pediatric stroke.
So like I said, within childneurology you're probably going
to see epilepsy and seizures ona day-to-day.
But if you're more interestedin a specific aspect it's kind
of nice to know you can dofellowships that usually last
about a year after the fiveyears of training.
Dr. Michael Kentris (04:57):
Excellent.
Now, obviously I'm biased.
So I did my likeneurophysiology slash epilepsy
training at Vanderbilt and I wasvery fortunate to spend about a
month or so on the childepilepsy service.
And I had this one distinctmemory in particular.
It was like the first.
It was one of the first days Iwas on service and I think it
(05:19):
was Dr Patterson perhaps I mightbe getting the name wrong.
I apologize, dr Patterson,perhaps I might be getting the
name wrong.
I apologize, but it was a childwho had a history of
Lennox-Gastaut syndrome and Iwas looking through it and I was
like, oh, there's a lot ofepileptiform discharges.
The EEG is pretty abnormal, butI didn't see any seizures.
And she's like, oh, are yousure?
And she's like, well, whatabout this?
And there was like the littleflattening there, sort of the
(05:43):
electro decadental response, ifyou will, and it's like, oh,
each one of these like five perpage is a seizure.
Dr. Shilpa Reddy (05:50):
And yeah, and she, I remember just saying
we're still like, don't worry,all of our adult fellows missed
that initially I mean it's sofunny that just you just said
that, because the fellowyesterday reminded me on her for
adult fellow on her first monthof peds there was two back back
to back EGs where there wasmultiple spasms on the EGs and
she's like I didn't see those.
But I always say you know,that's why you're here, that's
(06:11):
why you're in training.
Dr. Michael Kentris (06:13):
Right.
And now here I am, God, sevenyears later, and I still have
that core memory with me.
Dr. Shilpa Reddy (06:20):
Yes, I mean this is a little editorial, but
I do feel like, by quote unquote, missing things or getting
something wrong, you know, in asituation where you have support
, is the best way to learn,because as high achieving people
(06:45):
as we are, you're going toremember a time that you felt
embarrassed or a time where youdidn't have that knowledge or
you know so, at least for me.
Dr. Michael Kentris (06:49):
I think that's an interesting way to
learn, yes, that kind ofemotional tag to the learning
experience.
Now, as you mentioned, right,you are one of these people who
is more engaged with seizuresand epilepsy, in fact
instructing more juniorphysicians in becoming better at
it.
But just like with adultneurologists, we know child
neurologists are kind of at apremium across the country.
(07:09):
There's definitely not enoughpeople with the expertise kind
of scattered, especiallyuniformly across the country.
So it's not unusual, right.
People have unusual spells orepisodes, and if we were to talk
to the family medicine doctorsor the pediatricians out there
who are providing most of thiscare, this primary care, what
(07:29):
are the things that you wouldsay they should look out for?
That might warrant moreinvestigation.
Dr. Shilpa Reddy (07:35):
Yeah, I love this question because, as you
mentioned, neurologists bothadult and child neurologists are
a limited resource in ourcountry and we know that care is
not evenly distributed indifferent parts of our country.
So I think the more that we canempower providers in other
areas besides our academiccenters that are in bigger
(07:57):
cities, then I think we're goingto do justice for our patients.
So whether that means trying toagain educate the primary care
providers about how to treatcertain conditions, but mostly
education about when to refer tolike a bigger epilepsy center
for care, I don't want patientsto miss out on opportunities for
surgical management, you know,because other providers are
(08:27):
trying five, six, sevenmedications before thinking
about surgery.
And both in the adult andpediatric populations we know
that early surgery leads toimproved outcomes.
So more than ever we want to beable to streamline the
referrals and the workup and, ofcourse, the treatment that kind
of starts in the beginning, soI can speak mostly for pediatric
(08:49):
patients and that streamlinejust because I don't see adult
patients.
But you know we try to docontinuing medical education
seminars for generalpediatricians in our community
and the focus is on, again,seizures being a big part of
child neurology.
We focus on how to identifyseizures and seizure safety,
(09:11):
things like that.
So for our generalpediatricians, I think knowing
that seizures can manifest a lotof different ways clinically,
that kind of opens the door.
So if a patient comes in withweird behavior, weird episodes,
we really should be diggingdeeper into like okay, tell me
more about this episode so I canput them in a bucket of this is
(09:32):
seizure, this is not seizure.
And I start with really askingas many details as possible.
So, starting at the beginning,what were you doing when this
episode happened?
Then, what did you feel?
Then what did you feel?
And then, if there's a witnessor a bystander, kind of asking
the family or sibling saying,well, what did they do next?
What did they do next?
And then what happened at theend of that episode and it's
(09:54):
also important to interject andsay to the patient how much of
this did you remember, did youblack out?
Because that can help kind ofput us in one category or the
other.
And then going beyond that andsaying how, how many times did
it happen?
Um, how long does it last?
Um cause, like I said, thereare a lot of things that look
like seizures that aren'tseizures, but then there's also
(10:16):
some strange episodes that endup being seizures.
So, just kind of getting asmuch detail as possible so that
if you are able to connect witha neurologist at some point, you
can give them as much as astory.
Nowadays we have cell phones atour disposal, so we often ask
family members, or even teachers, if it's a younger kid, to take
videos with parents permission,because we always say, like
(10:37):
pictures are worth 1000 words,but videos are even better, it's
so true.
We, as humans, like to say weremember every single detail
about things.
In the moment of stress orpanic and, to your point,
getting emotion into it can canalter the way that we describe
things or remember things.
So videos are great absolutelyso I think the big things that a
(10:57):
pediatrician can can be lookingout for is is there sort of a
loss of consciousness or alteredawareness during the episode?
So we encourage family membersto ask them to do commands or
have them talk to them during it.
We look out for things that arevery stereotyped, meaning, does
the episode happen the same wayevery single time?
Yeah, and then beyond that, youknow, I don't know how much
detail we want to hear, but,like I said, different types of
(11:20):
seizures can manifest differentways.
So one of the most common onesthat we think about are absence
seizures, and it can really goboth ways.
So we see a lot, a lot, a lotof referrals for kids that stare
off or zone out, and it'sreally tempting for everyone to
say this is an absence seizurebecause they're staring, and
this is the type of seizure weknow is associated with staring.
(11:41):
So what I would say is it'sreally important to test
responsiveness in these patients.
And even though off-senseseizures classically are very,
very short, the zoning out orthe staring off is unresponsive.
So if you were to touch thepatient's face or give them a
little pinch, tickle them, theyshouldn't be able to respond or
break out of their episode,whereas kids that zone out or
space out, if you startle themin some way they might not
(12:04):
respond verbally but they'll atleast either shake their head or
blink or kind of tend towardsyou.
So that's an important feature.
And then for obstinate seizures, I think something to remember
is some kids can have some motormanifestations where they
flutter their eyelids, mighthave a little bit of lip
smacking, potentially evensomething with their hand.
So that might distinguish thattoo.
(12:31):
So the tricky part is ADHD is avery, very common diagnosis in
kids and it usually starts beingclear around that school age
five, six, seven years old,which also is the age where
absence seizures tend to be.
You know the onset.
So it can be very difficult totease out the ADHD staring and
attention from absence seizures,especially because we know kids
with absence epilepsy have, themore commonly have ADHD or
(12:52):
higher incidence of ADHD.
So if I can take a detour here,so there is an app that's being
developed, which I think kindof goes.
I'm sure you've talked about AIand things on your podcast, but
there's a lot of healthcaretechnology that we can start
incorporating to our practiceand I'm like super excited about
some of it being able to reachmore people or being able to
diagnose earlier.
I think that's great.
(13:13):
So this app is ahyperventilation app.
With obstinate seizures theytend to be induced by hyper
ventilation, but we often likeit's hard for kids to
participate in that type ofthing, especially if we're not
right there coaching themthrough it.
So the app basically coachesthe kid to hyperventilate using
some fun I don't know techniques, and then there's a little
(13:33):
camera that looks at the kid'sface and they can, I think uses
an algorithm to track if theyhave like eyelid fluttering or
if they have pauses in theirbreathing, for how long they
have like eyelid fluttering orif they have pauses in their
breathing for how long, and thenit'll be sent to somewhere
where the neurologist can reviewit.
Or there's like an algorithmthat reviews it and then it
spits out a report saying, hey,this kid had three they can't
(13:54):
call them seizures, but likethree episodes where there was
behavioral arrest or eyelidfluttering and then the
neurologist can look at it, oreven a pediatrician if they have
this app in their office, theycan look at it and be like, oh
well, this looks concerning, letme send them to the neurologist
, if that makes sense, and Ithink it's a nice way you can
use it twofold.
One is pediatricians can helptriage their referrals for
staring.
(14:14):
If it doesn't show up asanything, maybe they go down the
ADHD path or they can see theneurologist in a couple months.
But if the report spits out andsays, hey, there's three
episodes that sound concerningfor seizures, they can call the
neurologist and say I need thiskid seen for an EEG, like in the
next couple of weeks, you know.
And then neurologists can useit, because if we have a kid
that has absence seizures, thenwe're starting medication and we
(14:36):
want to monitor the response totreatment.
We can have the family do thisat home and say, okay, well, we
still had episodes like maybe weneed to up the medicine, I
don't want to wait the sixmonths before my return
appointment.
So I think it's exciting and Ihope that it starts being
incorporated into practice inthe future.
Dr. Michael Kentris (14:54):
No, that's really neat.
That's not something I wouldhave thought about because I
also get many consults in theadult world for staring spells,
slash absence, seizures and Ihave to say, no, that's for
children.
Dr. Shilpa Reddy (15:08):
Yes, and even so, like I would say, a large
portion of our patients in ourpediatric epilepsy monitoring
unit come in for staring spellsthat end up not being seizures
because kids, like I said, theyzone out, they have an attention
.
It's just a common thing.
Dr. Michael Kentris (15:24):
Right, yeah , I know, in the adult world,
you know, nearly half also endup being non-epileptic.
So it's one of those thingsthat when you go into the field
you're like, oh, I thought I wascoming here to take care of
epilepsy and seizures.
It's like, well, there's a lotof other things that are in the
kind of the orbit of thosediagnoses that you end up being
(15:44):
the person best equipped to tohandle a hundred percent I was
just gonna say, sometimes I feellike more, like, like more than
an epilepsy specialist.
Dr. Shilpa Reddy (15:53):
You're kind of like a spell specialist yes,
that's a good way of saying that.
Well, so in that same vein,there's a lot of things that can
look like seizures.
Syncope is one of those that'sfairly common in kids and not
dangerous per se.
Psychogenic non-epilepticspells I'm sure you've had like
a podcast on that.
(16:15):
I think that's super importantto talk about.
But just understanding thesequence of events and the
responsiveness of a patient canhelp any provider really think
about is this in the category ofnon-epileptic or the category
of seizures?
So yeah, a lot of differentinteresting episodes, but videos
have been great.
I I again with family'spermission I've had
(16:36):
communications and relationshipswith pediatricians where if
they can just send me a video, Ican triage that pretty quickly
rather than, oh, putting it inthe queue to like, maybe I'll
see you in six months when wefinally have an opening.
Dr. Michael Kentris (16:51):
No, absolutely.
Yeah, Triageing is so importantand, as you said, the video,
not always but very often, canprovide such good insights to
someone who knows what to lookfor.
The semiology is what we in thebiz call it, but basically just
like the clinicalmanifestations of the event, and
it's one of those things where,you know, I consider in
(17:13):
neurology, like the movementdisorder specialist, to be kind
of like the grandmasters of this, but I feel like we're maybe,
you know, second place in termsof like looking at an event,
what's happening.
You know, it's the story of thespread of an event, or of a
non-epileptic event as well, andit's one of those things where
(17:35):
I really appreciated my trainingat Vanderbilt, where I kind of
think of it as like the athleteswho had run tape after after a
game and they're watching.
You know it's like like well,did you notice this?
No, it's like all right, let'sgo back again and we'll watch it
again.
And you just do it over and overagain for hours every week and
it really just drills into you.
You know, making sure that themind recognizes what the eyes
(17:57):
are seeing, if you will, andit's kind of one of those weird
skills that you don't reallythink about but like becoming a
trained observer of a phenomenon.
Dr. Shilpa Reddy (18:05):
Yes, yeah, we have the.
You know, we're fortunate tohave a lot of practice, like you
said.
I mean, there's been studiesthat show like different levels.
So, if you're a patient versusprovider, versus family member
and like that, are you aneurologist, are you
epileptologist?
And the accuracy of detecting anon-epileptic spell versus a
seizure, um, it gets a littlebit better and better as, like,
(18:27):
the more training that you have.
But we're honestly like, we'regood but we're not.
We're not perfect by any means.
Dr. Michael Kentris (18:31):
no, no but it's interesting I have been
fooled uh, more times than Icare to think about.
Dr. Shilpa Reddy (18:37):
I think I was fooled today.
Dr. Michael Kentris (18:41):
Every day is a new opportunity.
Dr. Shilpa Reddy (18:43):
Yes, for learning yes.
Dr. Michael Kentris (18:47):
So so you know you are in an instructor
role and, as you mentionedearlier, there are certain kinds
of people who are maybeattracted to the specialty.
But what kind of skills doessomeone accrue in particular in
a child epilepsy trainingprogram or just a general more
(19:08):
neurophysiology epilepsytraining program that might give
them a leg up in these kinds ofparticular patient populations?
That?
Dr. Shilpa Reddy (19:16):
might give them a leg up in these kinds of
particular patient populations.
I really love this questionbecause I've been asked this a
few times as fellows or, excuseme, applicants have been
applying to our fellowshipprogram this year and they
always ask what are you lookingfor in a fellow?
I was like, okay, let me tellyou, michael Kendrick Only half
joking, but really honestly, asan epileptologist, I think you
(19:36):
hinted at this you really needto be detail oriented.
So, although, in order totriage patients to our clinic,
we want to get kind of a bigpicture of what the story is and
what the what these episodeslook like, the semiology, what
we are looking for when we'reanalyzing seizures is like the
nitty gritty of okay, did theirface turn this way for one
second before their eyes went?
(19:56):
Was it their left hand that wasdoing a dystonic movement
versus a rhythmic movement,versus you know so there's so
many details that help uspinpoint exactly where the
seizures are coming from, whichis going to be really important
to if we wanted to do surgeryand take that area out.
That is like the first step.
So very, very important to bedetail oriented.
You know that even drills downto when we're reading the EEG.
(20:20):
Let's say it's not epilepsysurgery, it's an ICU patient
being able to describe thewaveforms in a way that if I
sent this report to you, michael, you would be able to draw this
out.
I think Dr Pagano maybe toldyou that too.
You should be writing a reportwhere I could take it and draw
the EEG and it looks exactlylike the one that's running.
So I think that's a very goodskill set to have.
(20:43):
I think as an epileptologist,you really need to be curious.
I think in every field there'sso much more to learn.
But I can only speak toepilepsy, and I think there's so
much more to dive into.
I talked about kind of thehealth tech part of things, but
there's also more to dive intoin regard to surgical devices
(21:04):
that are being implanted and howwe're actually looking to cure
epilepsy rather than treatepilepsy.
So having that intellectualcuriosity is super, super
important.
And then I think this is generic, but I, I guess I I want people
that are interested in learningand I don't know if that's the
same as being curious, but Iwant them to be engaged.
(21:25):
I never want to take anythingfor face value, I guess.
So if you're an epileptologist,you're always thinking about
what else could this be and whatelse can I do for my patient.
I think we do everybody adisservice if we just say, okay,
return patient on your meds,they're happy, let's go bye.
I think there's alwayssomething to be not actually
(21:47):
changed, but something to talkabout and discuss and make sure
that you're engaging with thepatient for more than just their
seizures.
Are we talking about quality oflife and mood, their social
situation?
Because, again, you can have awhole podcast about living with
epilepsy and what that means atdifferent stages of life.
So I think that is kind of whatI mean by pushing a little bit
(22:09):
deeper with learning andcuriosity.
Dr. Michael Kentris (22:12):
Yeah, no, I think I'm sure that you've seen
some of these lectures of theyear with Dr Ben Bades.
I might.
I think, um, I sure, I I'm surethat you've seen some of these
lectures of the year with uh DrBen bodies I might be
mispronouncing his name from uhfrom Florida, but he's, he's
always.
You know, maybe you get thatreferral and you know you've got
an EEG report that shows, youknow, sharp waves in this, that
or the other area.
And you know, there there is asometimes a bit of skepticism.
(22:35):
Right, you have to trust, butverify if you will.
And so I know we certainly seethat same thing on the
neuromuscular EMG side of thingsand I would say at least to the
same extent on the epilepsyside of things, where you know
it really becomes a question oflike, do I know this person and
do I trust their clinicaljudgment as well?
(22:57):
And I know that sounds like abit of a hard nose take.
But if you just, as you said,accept it on face value, more
often than not you end upgetting burned a little bit.
Dr. Shilpa Reddy (23:10):
Yeah, that is a very good conversation.
I had it with one of ourfellows multiple times this year
.
I like to trust but verify.
I think that I think that's agreat outlook on life and I
think it's a very nice way ofsaying that.
Dr. Michael Kentris (23:25):
It's probably the nicest way I can
say it.
Dr. Shilpa Reddy (23:26):
Yes, yes, I mean just to be completely
transparent.
I mean there are patients whereI will read the patient in
August and I'll say I think thisis a arousal pattern from sleep
, that's totally normal.
And then we read it again sixmonths later, like me, the same
me, and I say oh no, this is,this is definitely a frontal
(23:46):
lobe seizure.
So that's happened a few timesin my career and I would be
surprised I mean, I'm sure ithappens to everybody.
So I think it's okay.
Dr. Michael Kentris (23:54):
It's okay to look at things with a
different lens, whether it's youor one of your colleagues or
another institution, you know ifyou'll indulge me, but the
phenomenon we call over-readingor under-reading EEGs, that is,
(24:20):
say, calling something abnormalwhen it's normal versus calling
something normal when it'sabnormal.
And I think we all go throughphases At least when I've worked
with residents in the past, thefirst couple of months they
miss everything.
They don't pick up on anyabnormalities whatsoever.
And then, after they've done afew months of reading EEG, then
everything's abnormal, like isthis a central spike?
(24:43):
No, that's a vertex wave andall these things right.
You kind of go through thesewaxing and waning phases where
you're under-calling,over-calling, you just bounce
back and forth through theextremes until hopefully, you
wind up somewhere in the middle.
But there are still those caseswhere you're just like ah, I
don't know, this one's a little,it's a little funny looking,
(25:05):
but I don't have enough data tosay like, does this correlate
with every episode?
The person has Right and toyour point, you know, you maybe
you get that second study andnow you have this and you're
comparing it to your past oneand it's like well, this changes
the entire lens that I waslooking at it through.
So it's not necessarily thatit's now abnormal as much as
like putting these two piecestogether gives you like a bigger
picture of the whole.
Dr. Shilpa Reddy (25:26):
No, I love that and I think that's I mean,
there's so many pearls to besaid in this one is.
You know, I think I'm known asa master hedger in EEG reports
because I don't like committingto something.
If I myself have a little bitof doubt, I don't want to put it
down there that, like, I'm 100%sure that this is, like you
said, abnormal or normal.
So I think it's better to talkabout it because you need the
(25:47):
clinical context and sometimestime Things declare themselves
right.
Dr. Michael Kentris (25:51):
Absolutely.
Dr. Shilpa Reddy (25:53):
And then the last thing you mentioned about.
Dr. Michael Kentris (25:54):
you said Getting the pictures in time.
Dr. Shilpa Reddy (25:58):
Yeah, I think that is the hard and nice thing
about reading EEGs because Iwill say I've been on both sides
where I read my own EEGs forpatients that I see on the
inpatient, outpatient side.
But there's a lot of timeswhere I read studies for my
colleagues who arenon-epileptologists on the
inpatient service and so it'stempting to like want to change
(26:19):
my read because of somethingthey said in their notes but
without seeing the patient.
You know, I think I try to beas quote unquote clean as
possible in my EG reads, if thatmakes sense you want to be as
effective as possible, becauseyou want your data that you're
adding to your clinical picture.
(26:41):
Each data point should beobjective, so that when you put
it together, then it's your turnto interpret.
Dr. Michael Kentris (26:46):
Right, and it's funny you mentioned that.
So after I graduated fellowship, I was at an academic
institution for a few years andI remember one of the chief
residents at the time said youneed to change the way that you
write some of your impressions,because the hospitalists don't
know what you mean, so they'reconsulting us on this basically
(27:09):
normal report.
And I was like, oh, and so thatis right, you have to keep your
audience in mind.
Who is going to be reading this?
I know that's one of the thingsthat they emphasize a lot, and
so I actually ended up shiftingaround so that, like, the most
generic aspect was at the top,so that if you wanted to get
into all the nitty grittydetails you had to scroll past
(27:30):
the actual impression, which Ithink stopped a lot of those
consults.
But but it was this thing whereit's just like, oh, this is just
the way I, I've been doing itand it's not working in this
environment.
So I had to change.
You know a little bit of how Iput the pieces together.
You know, change the verbiageslightly, right, there's a lot
(27:50):
of synonyms that we use, likeepileptogenicity versus you know
, uh, various other things, orseizure potentials, etc.
Etc.
And uh, know your audience Iguess, is.
The is the main takeaway forpeople who are writing reports,
whether it's eegs or anythingelse yeah, even when we get mri
reports from neuroradiologists,like they all you know.
Dr. Shilpa Reddy (28:12):
I think the point is you have clinical
context is important or clinicalcorrelations recommended.
Dr. Michael Kentris (28:17):
Absolutely.
Dr. Shilpa Reddy (28:19):
And I find it interesting with trainees in
general.
I think the point of doing moretraining is for you to know
what you don't know, and I think, as a trainee, it's just
natural for us to say, well, Ineed to know this, I need to
know this, I need to know this.
But, as an attending, thefurther that you step out, it's
(28:39):
really easy for me to say, hey,I need to know this, I need to
know this, I need to know this.
But, as an attending, thefurther that you step out, it's
really easy for me to say, hey,I don't know that and that's
okay, whereas, like you don'tknow that point, when you're a
trainee, you know everything but, as you mentioned, like we're
humbled a lot of times by, bynew information and you know
things don't fit in a box alwaysI know it feels like every time
I'm asked a question anymorethese days I have to start with
well, it depends.
Dr. Michael Kentris (29:01):
I can't just give an answer anymore.
Dr. Shilpa Reddy (29:02):
I've reached that stage in my career I know I
think I got feedback um acouple years ago from the
residents and they're like youknow, dr, ready doesn't like
commit and I'm like it's reallyhard, like when I don't have
data, to say, yeah, 100 rightthing to do yeah, but that that
really, I mean that's, that'smedicine, right, it's just, uh,
the the practice of medicine.
Dr. Michael Kentris (29:23):
It's because, yes, we have all these
big highfalutin studies, butwhen you try and break them down
to an individual, sometimes itdoesn't always work the best yes
, I totally agree so you knowwe've we've talked a little bit
about kind of like eeg trainingyes, I totally agree is when we
have these kids who grow up andthey start to age out of the
(29:45):
child neurology clinics.
And obviously a lot of kids withepilepsy they do grow up, they
reach adulthood and then theyhave to eventually find an adult
(30:08):
neurologist, which, let's justsay, I'm aware that there is an
ethos difference in terms of theamount of, let's just say,
white glove service that cansometimes be found.
And what do you find are themost helpful things If you're
going to say, talking to afamily or even to an adult
(30:28):
neurologist who's getting one ofthese people you know, children
with epilepsy who are kind oflike hitting the 18, you know
plus mark, and they're coming toyour clinic.
What are the considerations,especially for the more, let's
just say, not straightforward,you know, not like juvenile
myoclonic epilepsy, people withintellectual disability, etc.
Dr. Shilpa Reddy (30:46):
And we know that based on you know, studies,
papers, literature that's comeout that that transition between
pediatric and adult formedically complex patients not
just epilepsy, but you know, inall realms is super, super
important.
And when it's not done well, wesee a lot of patients lost to
follow-up, we see more ER visits, we see more just like
(31:07):
healthcare expenses, all thatdepression, quality of life
suffers.
So one I'm really glad you'reasking that question because we
need to have awareness that thisis a problem not just here
across the world, but there aresome clinics and institutions
that are doing a really good jobwith the institution, with
transition clinics.
And what a transition clinicincludes is obviously that
(31:32):
support from the adultneurologist or evolutologist as
well as the pediatric side, butit also that support from the
adult neurologist or optologistas well as the pediatric side,
but it also gives support from,like, a social work perspective
or case management, somebodythat is there to figure out.
Okay, how do I make thatinsurance transition, as some of
these kids, most of these kidshave conservatorship um, from
their parents.
They need adult, you knowguardians to take care of them.
(31:52):
They don don't havedecision-making capabilities,
and then also a psychologist,because there's a lot of
probably emotional stress andtrauma from the caregiver side
and, if the patient is awareenough, that might be hard for
the patient as well.
So, having multidisciplinarysupport when you make that
transition, it's also kind of aphysical challenge to get all
(32:15):
these people in one space.
It's also, just to be totallyfrank, there's going to be
billing and financial issuesthat come from sharing the
resources, so to speak.
So, as much as I say it'sreally, really important to do
this.
It's not that easy to actuallyexecute, but the first step is
talking about it.
So I'm glad you brought it up.
(32:38):
And what I do personally is Istart prepping patients when
they are 15, 16 years old andstart saying like, okay, you
know, as you get to that 18, 19,20 years old, we need to start
thinking about one.
What does life look like?
So?
Are they independent?
Are they going to go to college?
How are you going to learn totake your meds and get follow-up
appointments?
Are you going to be safe withsleeping, safe with alcohol and
(33:02):
drug exposure, sleep deprivationAll these things are super
important when you're not livingunder the roof of adults that
are telling you what to do.
And then, for patients that arenot independent in terms of
daily activities, what does lifelook like for the caregivers?
You know they're not going tobe in school every day, so are
they going to be in a group home?
Are they going to be in a likea work program?
You know things like that.
(33:22):
So I start asking thosequestions around, like, like I
said, 16 ish.
And then, when they're 17, 18,and they cross that technically
being an adult age, I alwaysgive one or two visits of okay.
At the next visit we're goingto try to identify somebody that
you want to see in adultneurology, whether that's in the
same institution or findingsomebody closer to home.
(33:43):
So at least it gets themthinking, without dropping the
surprise on them and saying okay, you're 18, bye, because that
can lead to a lot of emotionalstress and like tension and, as
you kind of hinted at some ofthese families, because they've
had epilepsy for a very longtime, they become attached to
that specific provider.
And so it's a relation, it'shard to say goodbye on both
(34:06):
sides, like for us and for them.
So I think just trying to likebring it up slowly and gently at
a few different points Good.
I always find that if I find,if I can refer to a provider
that I can what's the word, um,that I, yeah, vouch for exactly
that I know personally then Ican say, oh, you should see, dr,
(34:26):
so-and-so, they're going to bereally great with your daughter
or your son because they're kindor they're funny or they're
super smart or they're gentle,like whatever it is that I think
that patient needs is.
While I'll try to, I'll try tolike connect them with a
provider that's going to be agood fit.
Does that make sense?
Dr. Michael Kentris (34:43):
Yeah, a personal recommendation.
Dr. Shilpa Reddy (34:45):
Yeah.
No, that's excellent,everybody's for everybody, you
know we all have different.
Dr. Michael Kentris (34:49):
This is very true.
Dr. Shilpa Reddy (34:57):
And then I guess I do want to hint on this
because we're kind of tyingtogether education People always
ask when they're applying forthis fellowship, like I'm a
pediatric neurologist orpediatric epileptologist, how do
I run the adult and pediatricepilepsy program?
Because I kind of live in bothworlds and I always say, like
epilepsy is a lifelong journey,it's a lifelong story.
So if you see a patient that's35 and they have temporal lobe
epilepsy from like a structuralcause or maybe even not a
(35:19):
structural cause, more thanlikely they probably started
having seizures when they wereyounger, maybe a teenager or a
kid, when they had febrileseizures.
So you need to understand theirjourney of how they got there.
On our side, as a pediatrician,I need to understand that when
I have a five, six, seven,eight-year-old that has
intractable epilepsy, I want tobe able to treat that now so
(35:39):
that when they are 35, what doestheir life look like if they
continue to have epilepsy, withthis frequent of seizures?
Or can we do something now?
Or let's say you are trying tocounsel a 17-year-old about a
new diagnosis.
Are they going to outgrow thisin two years, five years, ten
years?
If I don't understand the lifecycle of a particular diagnosis.
(36:00):
I can't tell them like, oh, youcan have kids or you're never
going to work.
I need to understand it right.
So when we train both adult andpediatric neurologists,
epileptologists, they getexposure in both worlds, both
adult and pediatric neurologists, epileptologists.
They get exposure in bothworlds, not so much that they're
going to be seeing thesepatients every day, but just
understanding where they camefrom or where they're going.
Dr. Michael Kentris (36:21):
Right, getting the big picture.
To be honest, I have found thatsuper helpful in my own
practice as well.
We don't have as muchgeneralized epilepsy or
epileptic encephalopathies inthe adult population, but you
(36:45):
know it's not unheard of that weget.
You know someone in their 40sor 50s who has Lennox-Gastaut.
You know went through the wholecycle with West syndrome when
they were younger, etc.
And so they come in on, youknow, a fairly complicated
regimen of anti-seizuremedications which can be a
little intimidating if you'reunfamiliar with all the
interactions and the levels andall the pharmacology in play.
So I would say there's the wholespectrum the diagnostic aspects
, with reading the EEGs andbeing familiar with what all the
(37:07):
squiggly lines mean, and thenknowing the existence of the
syndromes and then knowing thepharmacology for the treatments
and then the surgical treatmentsthat we, you know we didn't hit
on a lot.
Just that's an entireconversation too.
But what are the options?
Right?
And I think this is just thetip of the iceberg.
We're talking just aboutpediatric epilepsy, but this
(37:28):
applies to all thesubspecialties within neurology.
There are all of these thingsbeyond even what we know, that
all of these, our subspecialtycolleagues in each of these
fields are experts within, andit is one of those things where
medicine at large and neurologyand then each subspecialty of
neurology is expanding at such arapid rate it's nigh impossible
(37:52):
to keep up on the latestadvances in every field.
It's a very Herculean task.
Dr. Shilpa Reddy (37:58):
Absolutely.
It kind of takes me back to oneof my first rotations as a
medical student.
I was on a rotation and theclerkship director said the
biggest mistake you can make asa doctor is not asking for help
when you need it.
And I think that kind oftouches on what you're saying is
if I don't know thesesubspecialties exist, if I don't
know this treatment exists, Idon't have to be able to do it.
(38:19):
I just need to know that I needto call somebody else.
Dr. Michael Kentris (38:23):
Right, yeah , and I think that's that's one
of the things I love the mostabout about the neurology
community is that everyone is sowelcoming.
And you know, it's so great tobe able to reach out to people
who helped me become theneurologist I am and, uh, other
people who I've interacted withover the years or who I've even
helped train early in theresidency and then they went on
(38:45):
and did different specialty.
I can call up my formerresidents and ask them like, hey
, you're a neuromuscular guy now.
Uh, what do you think aboutthis?
Does this sound like something?
And I get advice myself.
Yes, so it's very good to havethis network, this community of
people that you can, like I said, you can trust who's a clinical
(39:06):
acumen that you helped form,you've seen in action.
You know these people arereliable.
It's such an invaluableresource.
It's just being able to reachout to people and ask their
opinions.
Dr. Shilpa Reddy (39:19):
I couldn't agree more.
Dr. Michael Kentris (39:20):
Any final thoughts that you would have for
people who might be maybeconsidering child neurology or
even pediatric epilepsy as afuture specialty?
Dr. Shilpa Reddy (39:31):
I would say for child neurology, just know
that there's a lot of differentoptions and spaces that you can
be in, even after doingresidency training, and the same
goes for being a pediatricepileptologist.
We train two different types ofepileptologists.
One is they want to do surgicalepilepsy stereo EEG device,
implants, all that kind of stuffand then we also train equally
(39:54):
as many people that go into apractice where they are not
doing surgery and they're not ata level four epilepsy center
but they are providing reallygood care for their patients
because they know, of course youknow, like, how to read their
EGs and interpret them, but theyknow when to refer for surgical
management.
And I think we need just morechild neurologists, more
(40:16):
epilogue psychologists, we needmore of everybody so that we can
reach as many patients aspossible.
Dr. Michael Kentris (40:22):
Absolutely.
If people want to find out moreabout your work or your work at
Vanderbilt, where should theylook?
Should they track you downonline?
How would you recommend gettingin touch?
Dr. Shilpa Reddy (40:32):
Don't come to my house.
Should they track you downonline, how would you recommend
getting in touch?
Don't come to my house.
Dr. Michael Kentris (40:39):
But so we have.
We have a ex, the old Twitteraccount, yes, formerly known as
Twitter yes, Formerly known asTwitter.
Dr. Shilpa Reddy (40:44):
It's at V-U-M-C, p-e-d, e-p-i-l-e-p-s-y,
at V-U-M-C.
Peedepilepsy is our handle.
I'm the one that runs theaccount, so feel free to reach
out to me or DM me.
That way, you know our our.
We have a website for thefellowship pages at Vanderbilt
(41:05):
on the neurology website yeah,that sounds great.
I was like I don't know the linkor anything, but I think if you
are, if you're specificallyinterested in, you know, coming
to vanderbilt, just likelearning about what I do, then I
think dming me on x uh wouldprobably be the I know it just
doesn't sound right in the mouth, does it?
(41:25):
yeah, it doesn't, it doesn'troll off the tongue, but, um,
yeah, I think I've connectedwith a few people that way and I
think it's nice to kind ofstart the dialogue and then we
can email or chat on the phone,whatever people are interested
in.
Dr. Michael Kentris (41:38):
Awesome.
Thank you so much.
You can also find me on X I'mat Dr Kentris D-R-K-E-N-T-R-I-S,
or you can follow theNeurotransmitters at neuro
underscore podcast and check outour stuff on the website at the
neurotransmitterscom.
Dr Reddy, thank you again.
I really appreciate you takingthe time to talk with us today.
Dr. Shilpa Reddy (42:01):
Thank you, Michael.
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