Please tell us about yourself.

Vishal Mandge, MD, MPH, first saw the clinical value of EEGs when his mentor used them to pinpoint the reason why one of Mandge’s friends was having a seizure. Now, as one of our clinical neurophysiology fellows, Mandge is interpreting EEGs on a regular basis, while also treating patients with epilepsy and conducting clinical research. For this week’s “Fellow Spotlight” interview, Mandge talks to us about his current and early interests in clinical neurophysiology, how he uncovered a link between hypertension and drinking diet soda as a graduate student, and why he wants a career as a clinician scientist.

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What are your current responsibilities as a clinical neurophysiology fellow? What does a typical day for you look like?

As a clinical neurophysiology fellow, I am responsible for interpreting inpatient prolonged video EEGs, routine and ambulatory EEGs, determining the eligibility of patients with medication refractory epilepsy for epilepsy surgery and educating neurology residents.  

When I am working the dayshift, my day starts at 7 a.m. I start reading prolonged EEGs, for either adult patients or pediatric patients in Duke University Hospital or Durham VA Hospital, and then I review them with the epilepsy attending. After that, we perform in-person rounds at either the adult or the pediatric epilepsy monitoring units depending on rotation. 

In the afternoon, besides reading prolonged EEGs, and reading STAT requests for routine or prolonged EEGs, I see patients in epilepsy clinic two days a week or read routine EEGs once or twice a week with neurology residents and attending. Some days, I attend OR for patients who are undergoing implantation of intracranial electrodes for confirmation of proper functioning of implanted electrodes. When time permits, I work on research or spend time in the OR receiving training in neurophysiologic intraoperative monitoring. When I am working nights, the day starts at 5 PM, and besides interpreting prolonged EEGs, I interpret ambulatory EEGs.

How and when did you first get interested in neurology?  What about clinical neurophysiology interests you the most?

My interest in neurology sparked when one of my friends got admitted to hospital for new onset seizures, while I was working as a hospitalist in Alabama. Focal epileptiform discharges in EEG led us to look for structural lesion in her brain despite a negative MRI of brain. Ultimately, an MRV recommended by my mentor Dr. Alapati identified venous sinus thrombosis which had caused subtle changes in her brain tissue causing the seizure. This was my first experience with this incredibly useful skill of interpreting EEGs. I started becoming more aware of the squiggly lines on the monitors in the NSICU, started attending neurology conferences, and ultimately decided to dedicate my professional life to the field of neurology after working more than 5 years as a family medicine hospitalist physician. 

I find the most fascinating thing about clinical neurophysiology is the epilepsy surgery planning. With the introduction of depth electrode implantation integrating it with the new software and robotic technology, we can identify seizure focus with a lot more precision, and at the same time reducing the chance of complications.   

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 am planning to work in a reputed academic hospital like Duke, dedicating half of my time as a neurohospitalist and half as a clinical neurophysiologist. My ideal job would allow me to spend 20-25% of my time doing high-quality research, as I believe that there is a tremendous potential for neurology to grow as a field but unfortunately only a limited number of my generation of neurologists want to work as clinician scientists. 

You earned your MPH from East Tennessee State University in 2007. What area did you study, and how does that knowledge complement your medical training?

I did my Bachelor of Medicine, Bachelor of Surgery – MBBS from NHL Municipal Medical College

I obtained my Masters of Public Health with a concentration in epidemiology and biostatistics at East Tennessee State University. It helped me integrate principles of clinical and preventive medicine. It greatly enhanced my ability to review the quality of research papers and practice evidence-based medicine. This has earned me invitation to be a reviewer of major medical journals like Neurology, JAMA Neurology, and Journal of Clinical Neurophysiology to name a few. It also helped me learn the basic and advanced biostatistics, which has helped me conduct research studies. 

For your graduate thesis you examined national data on how beverage consumption in men and women was linked to hypertension. What were the main findings of that study? What implications do they have for improving public health?

I evaluated data for 18,953 subjects aged 18 years and older who participated in the Third National Health and Nutrition Examination Survey. The main finding was that diet soda and alcohol consumption had a statistically significant positive relationship with hypertension even after adjusting for demographic variables and body mass index.

 Other studies done afterwards have shown similar findings that diet soda is not a healthier alternative to regular soda, and it is associated with increased risk of not only hypertension, but obesity, diabetes and cardiovascular diseases as well. In my opinion, water is the best drink. The awareness about hazardous effects of regular and diet soda drinks in general public is increasing, but public health programs should address these in greater detail.