Dmitry Tchapyjnikov, MD, has spent the past five years bouncing between his current home at the Department of Neurology, and the Department of Pediatrics, where he completed his residency in Child Neurology. In this week’s spotlight, the current clinical neurophysiology fellow discusses the different challenges posed by children and adults with epilepsy, the implications a recent study he co-authored has for patient care, and loves of skiing, camping and family time outside of Duke.
What are your responsibilities as a Clinical Neurophysiology fellow? What does a typical day for you look like?
Depending on the rotation, we split our time between reading EEGs of either adult or pediatric patients. The day starts around 7 or 8 AM and mornings are spent reading prolonged EEG studies then reviewing them with the epilepsy attending. We have in-person rounds for both the adult and pediatric epilepsy monitoring units so there are opportunities to interact with patients, medical students, and residents. I spend afternoons reading prolonged EEGs, seeing patients in epilepsy clinic two days a week, reading routine EEGs once or twice a week, and working on research the rest of the time. We also spend time in the OR receiving training in neurophysiologic intraoperative monitoring, which is used to monitor nervous system integrity during surgeries involving the brain and/or spine. My co-fellows (Geetanjali, Jason, and Krystal) and sleep fellows (Damien and Sushil) make a great team.
How did you first get interested in neurology? What drew you to child neurology and neurophysiology in particular?
I have been interested in human behavior and the scientific/philosophical theories that try to explain it since I was a little kid. In college, I majored in neuroscience and thought I would specialize in adult neurology but found that I really loved working with and caring for kids. Child neurology is fascinating because diseases like epilepsy often coexist with other conditions like developmental delay, behavioral problems, and genetic/metabolic disorders. You see first-hand how one problem can affect the other and vice-versa. Epilepsy is the "bread and butter" of what we see as child neurologists so it felt natural to pursue neurophysiology training. With so many treatments available and many more on the horizon, it’s an exciting time to be an epileptologist!
You recently co-authored a JAMA Neurology study that found that prompt treatment for status epilepticus in children reduced mortality as well as the duration of seizure. What implications does this study have for patient care? What obstacles are in the way to providing prompt treatment to these children?
Our study really drove the point home that status epilepticus (SE) is a time-sensitive neurological emergency and that delays to treatment have important long-term consequences. We do a great job at treating other time-sensitive conditions like stroke and the same effort should be made to treat SE. The biggest ways to improve SE care is to educate providers and implement standardized treatment protocols that emergency physicians can use. We have done these things in the pediatric ED at Duke and its made a very positive impact.
You’ve spend extended time at Duke both within the Department of Pediatrics (for most of your residency), and the Neurology Department (now as a fellow and for one year of your residency). How much overlap is there between these two departments? Other than the age of the patients, what’s the biggest difference between those groups?
Although they are in separate departments, the adult and pediatric epilepsy physicians are a close-knit group and we have a joint epilepsy conference every Friday. There is less overlap in other neurologic subspecialties but I would love for the adult and pediatric neurology groups to interact more, I think we could gain a lot from discussing how we care for stroke and other conditions that can affect both adults and kids. Pediatrics is more casual, you rarely see ties or white jackets when rounding on the pediatric floor!
Tchapyjnikov and his wife Lydia pose while canoe-camping in Utah.
What plans do you have for after you complete your fellowship? If you could have any job in the world, what would it be?
I will most likely be joining Duke’s division of Pediatric Neurology as an epileptologist. It’s an awesome group of physicians and I’m excited to further expand the pediatric epilepsy program, continue my research, and teach students and residents. Any job in the world? As a ski fanatic, it would somehow combine neurology and skiing, maybe a ski-patroller neurologist that does slope-side consults?
What passions or hobbies do you have outside of the department?
My wife Lydia and I are avid travelers and have backpacked throughout Europe, Latin America, and southeast Asia. We also love camping and skiing. Our daughter Ramona is 2 years old and has already gone camping with us, I am hoping she will be skiing by 3 or 4!
Tchapyjnikov and family hiking in Washington state's Olympic National Park.