Cory Myers, DO, had a long interest in the brain and neuroscience, considering research and psychiatry before turning to neurology. Now, as one of our Clinical Neurophysiology Fellows, he is preparing for a career treating patients with epilepsy and related conditions in an academic setting. For this week’s “Spotlight” interview, Myers talks to us about the variety offered by a career in clinical neurophysiology and epilepsy, how his mentor Aatif Husain, MD, disarmed Myers in his first week of fellowship with a pair of flamingo socks, and spending time with his wife and daughter when he’s not at work.
What are your current responsibilities as a clinical neurophysiology fellow? What does a typical working day look like for you?
My responsibilities as a clinical neurophysiology trainee are threefold: interpretation of neurophysiological tests, mainly electroencephalograms, EEGs, which are requested in outpatient settings, as well as in intensive care and hospital settings. Often the purpose of these tests is to look for a seizure or related activity or to clarify the nature of a person with an altered mental state. I also help oversee the care of epileptic patients in the Epilepsy Monitoring Unit, EMU, and see patients at the Duke Epilepsy Clinic during the week, usually concerned about seizures or for management refractory seizures.
Additionally, each week there is an epilepsy surgery conference where patients with drug-resistant epilepsy are evaluated for surgery if they have a chance of being seizure-free or , if they are not eligible for resection, possible neuromodulation therapies such as VNS, RNS or DBS implantable device therapies. We collect clinical and neurophysiological data and present it in a format to help the department decide on the best approach for the patient.
Twenty percent of the scholarship is experiential learning in intraoperative neuromonitoring, IONM or IOM, which is a lesser-known niche in neurology and overlaps with anesthesiology somewhat. It monitors sensory and motor pathways for most neurosurgical patients, typically from toe to head, to ensure signals are maintained throughout the operation.
There are also evoked potentials for inpatients and outpatients, which have historically been used for the diagnosis of MS and have some clinical utility to date, for example post-cardiac arrest prognosis. (We perform EMG as part of IONM, but in a limited capacity compared to traditional EMG nerve conduction tests that neuromuscular specialists use to diagnose conditions such as ALS or myasthenia gravis.)
There is also a research requirement under the fellowship and may be quality improvement or retrospective clinical studies. I am involved in research comparing expert examiners to artificial intelligence in the interpretation of intensive care EEGs. I am also interested in a collaborative research project on non-invasive brain stimulation with Dr. Chaatbar from the stroke department.
How and when did you first become interested in neurology?
I have a long-standing interest in neuroscience and neurology as a subject. I think it may have stemmed from early life as a preteen, experiencing vivid dreams and casual conversations about awareness and perceived interest in my father as a literature enthusiast and writer. He often quoted Henry and William James at breakfast or dinner. I liked biology in high school and appreciated the bottom-up approach of neuroscience in undergraduate studies compared to psychology.
After undergraduate, I considered research and PhD as a career, so I spent time feeling it as a lab technician in Eric Kandel’s neuroscience lab, which focused on the basic sciences of learning and memory dealing with mouse models. I had my first clinical exposure at a local hospital in a sleep lab where I saw EEGs performed overnight for sleep staging. I had quite a broad interest so I kept my mind open.
I thought about psychiatry and primary care while in medical school, but kept coming back to neuroscience and neurology. Neurology patients tend to need a lot of primary care built into their plans because neurological conditions affect many aspects of life. So I’m not missing an opportunity for primary care.
How did you decide to specialize in clinical neurophysiology?
Deciding to pursue clinical neurophysiology was a meandering process. During my residency, I was interested in a variety of sub-specialties and had an interest in headaches, neuroimmunology or stroke. Each of them has very different scopes of practice and daily routines, intensive outpatient or inpatient hospitalizations.
I realized that epilepsy and neurophysiology were like a way of deciding not to decide because there is an overlap of most of the other neurology subspecialties. I felt like seizures and epilepsy was a confusing topic, so I wanted to know more about them. Neurophysiology caters to patients with a variety of degrees of disease severity, from unusual sensations or tingling to brain death, so the scope also covers inpatient and outpatient settings depending on preference.
During the epilepsy rotations, I enjoyed a little break from clinical activities to focus on the visual analysis of the EEG and the kind of puzzle-solving process that helps make sense of observed patterns. I find the EEG interpretation a bit meditative, like looking at the edges of a mandala painting.
I also did a rotation in intraoperative neuromonitoring at the suggestion of my program director, and found it fun and exciting, like playing jazz with neurophysiology in high-stakes surgeries due to the variety of arrangements of electrodes for each procedure. It’s also like the highlights of neurosurgery, and it’s a privilege to work with neurosurgeons. For example some resection procedures, the neurophysiologist becomes invaluable once the brain is exposed to ensure that no eloquent cortex is removed. I am doing two years of fellowship partly to allow me more time to learn additional IOM procedural skills.
I am doing two years of fellowship in part to gain more experience with the IOM in addition to more preparation to assess candidates for epilepsy surgery. There is a nationwide trend for adult neurologists wanting to mentor patients for epilepsy surgery to do two years of fellowship.
What plans do you have for your career after completing your scholarship? If you could have any job in the world, what would it be?
I want to continue serving communities from an academic medical center. I enjoy the collegial environment of academic medicine and the constant incentive for additional learning. I came to the scholarship with the intention of seeking jobs in academic medical centers and am in the early stages of this process. So my ideal job is similar to what my incumbents do at Duke. They have variety built into their schedule and rotate in the EMU for a week or two at a time and cover EEGs for the hospital. They also have a clinic two or three days a week and usually cover IOM one day a week.
There is some administrative time and time dedicated to teaching and research. The week ends with a conference on surgery and the meeting of minds is routine. I’ve kept an open mind to telemedicine as a career start because I’m starting a family and possibly having a second child, so working from home is attractive in the short term. A few fellows have done this and are very happy with it, so I’m looking into that as well.
What experience or aspect of the fellowship program stood out as particularly memorable or helpful to you?
I came to the program originally because it is one of the few on the East Coast that offers an exceptional experience with both presurgical epilepsy surgery assessments and intraoperative neuromonitoring and evoked potentials . I read Dr. Husain’s book as an introduction during my IONM residency rotation and my mentors in Georgetown wrote some of the chapters with him. He is world renowned for epilepsy and intraoperative neuromonitoring, so I was interested in working with him.
This year we had a visiting scholar from Mexico who also traveled from further afield to work with him, so I feel justified in moving for the fellowship. Of course, the OR is huge and there are plenty of IONM learning opportunities here as well. One of my first weeks on fellowship I had a clinic with Dr. Husain and I will find it hard to forget his disarming flamingo socks as part of his otherwise very professional attire for the clinic. It has been a relief to have a relaxed culture for educational and professional development. The weekly IONM conference has been a very useful complement to the other epilepsy education conferences.
I would be remiss if I did not mention Dr. Sinha, the program director’s excellent mentorship during this year. He was a very good role model in all aspects of his career and his field. I don’t think I’ll forget the time we did brain stimulation for a seizure and eloquent cortex localization in a patient who, after hearing the term Hertz for stimulation frequency, became alarmed with pain in the framework of the procedure. He was very compassionate in avoiding using the frequently used term and instead said “cycles per second” to allay concerns and keep calm during the procedure.
What other passions or hobbies do you have outside of the department?
My hobbies have changed a bit because I have a new baby this year. I moved to Duke when she was 3 months old and she will be one next month. I loved running for exercise and mental breaks. Now I have a jogger and like to walk the neighborhood wooded path and go to the playground.
During the summer I use the community pool for a quick workout. Otherwise, I like to use the library app, Libby for audiobooks and podcasts. I loved the language and was studying Mandarin Chinese in college. But now I’m learning Tagalog from my wife with my little girl.
Myers spends time with his wife and daughter when he’s not at Duke.