Epigraph Vol. 21 Issue 2, Spring 2019

Master’s program in epileptology enters its 20th year (on a surprisingly low budget)

There is no question that the lack of resources is a major impediment to epilepsy care in many regions of the world. This is usually because there aren’t enough medical personnel with the knowledge and skills to diagnose, treat and manage people with epilepsy.

Chahnez Triki
Chahnez Triki

“There is little time dedicated to epilepsy in medical school,” said Chahnez Triki, professor of neurology and pediatric neurology at the University of Sfax, Tunisia. “Here, epilepsy had been managed mostly by psychiatrists. There are few neurologists in the area, and at the first-line level of care, there are no neurologists.”

To provide epilepsy training and education to local health professionals, Triki and others at the university started a master’s program in epileptology. Now in its 20th year, the program has enrolled more than 300 students. Designed for specialists, the program also accepts general practitioners who work in rural areas, or in areas without practicing neurologists.

For generalist students, said Triki, “Their goals at the beginning are to diagnose and treat people with epilepsy, but over the course of the program they become aware that diagnosis and treatment can be difficult, and they refer difficult cases to a neurologist,” she said.

About 60% of students are neurologists; the others include pediatricians, neurosurgeons, psychiatrists, and others.

E-learning since 2005

The two-year program attracted about 20 students in its first two iterations. Through word of mouth, the program quickly became known; soon, students from other countries were asking how they could attend. In 2005, the program shifted to an e-learning platform, allowing for online classes and communication.

Though the online format expanded the reach of the program to virtually any French speaker, the university limits the program to about 30 students per year to allow for individual attention and maximize student interactions. Historically, between 25% and 40% of each class has been from Sfax, but the most recent graduating class (2018) included students from across Tunisia, as well as Senegal, Algeria and Jordan. Past classes have included students from Morocco, Djibouti, France and Togo.

The curriculum includes five modules, which are covered over four semesters:

  • Fundamentals of epileptology – physiopathology and introduction to the research
  • Diagnosis, classification, epidemiology and semiology
  • EEG, other neuroimaging and presurgical assessment
  • Epilepsy types – includes syndromes, epilepsy in neonates, infants, adolescents; women’s issues; epilepsy after trauma or infection
  • Epilepsy management – medications, surgery, other treatment methods, psychosocial issues, comorbidities, patient education, quality-of-life issues (driving, sports, marriage)

Requirements and exams

Coursework is completed through recorded lectures and online conferences, where slides and video are shared and students can interact and ask questions. The proportion of recorded lectures to “live” conferences varies. In addition to coursework, there are two or three face-to-face meetings per year at the university for practical clinical training. Students also are required to spend at least two months training in an epilepsy unit.

More than 40 faculty members and tutors are involved in the program, including several former students.

The program uses a credit point system. Students must accumulate at least 270 credit points. Points come from:

  • Participation in the courses, including presentations
  • Participation in national or international events related to epilepsy, including ILAE congresses
  • Continued medical training in the field of epilepsy
  • Practical internships
  • Assessments of information presented in each module

To earn the master’s degree, each student also must pass an exam at the end of each academic year, and present and defend a thesis.

The program was recently designated as a professional degree by the Tunisian Ministry of Health. This required the addition of 10 additional hours of practical training to the curriculum via case studies, video and discussion. Soon, Triki and other faculty will work to establish a level of proficiency for the program, in line with the ILAE’s recently published roadmap for competency in epilepsy education. (The roadmap has three levels: entry level, proficiency and advanced proficiency.)

Opening the mind to the complexities of epilepsy

Emna Elleuch, now a private-practice neurologist in Sfax, received a degree through the program. She said the course helped her acquire a solid foundation in epileptology that led to clear improvements in her daily practice. “I try to classify the epilepsy before treating,” she said. “I also know when and how to stop treatment, and that monitoring side effects is important.” Elleuch also noted that the program pushed her to learn while also helping her realize how vast the field was, which has helped her keep an open mind to further learning.

Wafa Bouchaala, now in the Department of Neuropediatrics at the University of Sfax, earned her Master’s degree in 2016. She recently finished a training course in neurophysiology—funded by ILAE-Eastern Mediterranean—at Necker Hospital for Sick Children in Paris.

“It was a pleasure to be a part of the master’s program,” said Bouchaala, who enrolled in the program with a focus on pediatric epilepsy and electrophysiology. “The program made me aware of new developments in definition and classification of epilepsy, the management of epilepsy in children, and in the interpretation of EEG.” She says the program improved many aspects of her practice, including analyzing seizure semiology, seizure patterns and etiology, and treatment choice.

Triki noted that although feedback has been positive, many students seem reluctant to get involved in patient education and the social aspects of epilepsy. “We have started asking students to participate in a national epilepsy day activity or some other activity involving patients,” she said. “But the interest in the social aspect is not as good as we would like.”

One other pain point is that only about half of the students take the exam to receive the degree. “The other half have the training, but not the attestation,” Triki said.

And about that surprisingly low budget: This longstanding academic program does everything on no budget at all. Students pay a fee to the university to enter the program, but all of the faculty and guest speakers volunteer their time.