ABCN Handbook

Download - 2013 ABCN Handbook

Part 1 Examination Information

The three-hour examination will be administered during an established two-week testing period at LaserGrade/PSI Computer Testing, Inc. The examination consists of 120 objective, multiple-choice questions. Admission to the examination requires submission of the application and application fee. Once accepted, the examination fee of $450 is due to ABCN.

LaserGrade/PSI has several hundred computer-based testing sites in the United States. Scheduling is done on a first-come, first-service basis. To find a testing center near you visit: www.lasergrade.com. Please note that hours and days of availability vary at different centers. You will not be able to schedule your examination appointment until you have received an Eligibility Notice from PTC.

If you do not receive an Eligibility Notice or other correspondence at least three weeks before the beginning of the two-week testing period, contact the Professional Testing Corporation by telephone at 212-356-0660.

If you need to cancel your examination appointment or reschedule to a different date within the testing period you must contact LaserGrade at 800-211-2754 no later than noon, Easter Standard Time of the second business day PRIOR to your scheduled appointment. There are no refunds for this examination. If you fail to arrive for your appointment or cancel without giving the required notice, you will forfeit your testing fee.

A candidate who fails the Part I examination may repeat the test within two years without filing a new application by advising the Executive Director and submitting a second examination fee no later than six weeks before the examination. If the candidate does not pass the examination within five years, a new application, application fee, and examination fee must be filed with the Board. Eligibility requirements will be those in place at the time of the new application.

Outline of Content Part 1

  1. Physiology and Instrumentation
    1. Physiology
      1. Anatomy of neural generation
      2. Mechanisms of EEG and evoked potential generation
      3. Pathophysiology of abnormal waveforms
      4. Basic mechanisms of epileptogenesis
    2. Instrumentation and Acquisition Procedures
      1. Basic electricity and electronics
      2. Amplifiers and their characteristics
      3. Calibration
      4. Filters
      5. Localization and polarity
      6. Artifacts
      7. Electrical safety
      8. Computers and principles of averaging
      9. Electrodes and their application
      10. Techniques of ECS determination
      11. Statistics
      12. Long term monitoring
      13. Instrumentation and safety in the operating room
      14. Principles of EEG digitalization
  2. Clinical EEG
    1. Basic EEG Patterns From Prematurity to Senescence
      1. Maturational changes
        1. Neonatal
        2. Other age related changes
      2. Normal adult patterns-wake
      3. Normal variants
      4. Activation procedures
    2. Clinical Correlation
      1. Seizures
      2. Other paroxysmal and transient conditions
      3. Focal lesions
      4. Diffuse and multifocal encephalopathies
      5. Coma
      6. Brain death
      7. Drug and other treatment effects
      8. Patterns of uncertain significance
      9. Disorders affecting sleep patterns
      10. Periodic patterns
      11. Neonatal disorders
      12. Extended monitoring
    3. Sleep
      1. Physiology
      2. Instrumentation
      3. Clinical
  3. Clinical Evoked Potentials
    1. Visual
      1. Stimulus and recording techniques
      2. Physiological parameters
      3. Standard parameters of stimulation and recording
      4. Criteria of abnormality
      5. Clinical correlation
    2. Auditory
      1. Stimulus and recording techniques
      2. Physiological parameters
      3. Standard parameters of stimulation and recording
      4. Criteria of abnormality
      5. Clinical correlation
    3. Somatosensory
      1. Stimulus and recording
      2. Physiological parameters
      3. Standard parameters of stimulation and recording
      4. Criteria of abnormality
      5. Clinical correlation
    4. Event related
      1. Stimulus and recording techniques
      2. Physiological parameters
      3. Standard parameters of stimulation and recording
      4. Criteria of abnormality
      5. Clinical correlation
  4. Sleep
    1. Technical, polysomnography
      1. Selection of appropriate recorded variables
        1. Neonates and children
        2. Adults
      2. Recording parameters for different variables
      3. Recording respiration
      4. Artifacts
    2. Physiology
      1. Sleep stage criteria
        1. Neonates and children
        2. Adults
      2. Patterns of drowsiness and sleep
        1. Neonates
        2. Children, adults, elderly
      3. Sleep indices criteria
      4. Normal sleep architecture
      5. Normal EEG patterns of drowsiness in children, adults and elderly
      6. Circadian rhythms and sleep
      7. Neural and neurochemical control of sleep patterns
      8. Effects of sleep deprivation, sleep needs
    3. Clinical aspects
      1. Effect on epileptiform activity and seizures
        1. Neonates and children
        2. Adults
      2. Common parasomnias
      3. Effects of drugs on sleep architecture
      4. Criteria of abnormal sleep architecture
      5. Disorders of excessive somnolence
        1. Polysomnographic testing in diagnosis
        2. Multiple sleep latency testing in diagnosis
      6. Disorders of initiation and maintenance of sleep
      7. Abnormalities of sleep in CNS disease
      8. Indications for sleep monitoring
  5. Intraoperative Monitoring
    1. SEP monitoring for spinal cord, brainstem and cerebral surgery
    2. BAEP monitoring techniques for eighth nerve and brainstem surgery
    3. EEG monitoring for cerebral surgery
    4. Motor evoked potential monitoring for spinal cord surgery
    5. Cranial nerve monitoring
    6. Criteria for decision making
    7. Influence of anesthetic agents
    VI. Epilepsy
    1. Applications and limitations of ambulatory EEG monitoring
    2. Applications and limitations of video/EEG monitoring
    3. Recognition of ictal patterns
    4. Correlation of EEG patterns with clinical syndromes
    5. Intracranial recording

References

The latest editions of the following references may be of some help in preparing for the ABCN examination. This list does not attempt to include all acceptable references, nor is it suggested that the exam is necessarily based on these references.

Abou-Khalil, B., Misulis, K.E., Atlas of EEG and Seizure Semiology. Butterworth-Heinemann, 2005.

American Clinical Neurophysiology Society Guidelines in Electroencephalography, Evoked Potentials, and Polysomnography. www.acns.org. 2006.

Aminoff, M.J. (ed.) Electrodiagnosis in Clinical Neurology, 5th ed. Churchill Livingstone, 2005.

Bloome, WT., Kalibara., M., Young.,GB. Atlas of Adult Electroencephalography, 2nd Edition. Lippincott, Williams & Wilkins, 2002.

Brenner, R.P. EEG on DVD – Adult: An Interactive Reading Session. Demos, 2007.

Butkov, N, Lee-Chiong, T. (eds) Fundamentals of Sleep Technology. Kluwer/Lippincott Williams & Wilkins, 2007.

Chiappa K. Evoked Potentials in Clinical Medicine, 3rd ed. Raven Press. 1997.

Chokroverty S. (ed) Sleep Disorders Medicine: Basic Science, Technical Considerations and Clinical Aspects, 3rd Edition. 2005.

Ebersole, J.S. and Pedley, T.A. (eds.) Current Practice of Clinical Electroencephalography, 3rd Edition. Lippincott Williams & Wilkins. 2003.

Fisch, B.J. Fisch & Spehlmann's EEG Primer: Basic Principles of Digital and Analog EEG, 3rd Revised and Enlarged Edition. Elsevier. 1999.

Geyer, J.D., Payne, T., Carney, P.R., Aldrich, M. Atlas of Digital Polysomnography. Lippincott, Williams & Wilkins. 2000.

Goldensohn E.S. (ed) et al Goldensohn’s EEG Interpretation: Problems of Overreading and Underreading, 2nd Edition. Futura. 1999.

Husain, A. (ed). A Practical Approach to Neurophysiologic Intraoperative Monitoring. Demos: New York, 2008.

Iber, C., Ancoli-Israel S., Chesson, A.L., Jr, Quan, S.F. for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events. AASM. 2007.

Kartush, J.M. and Bouchard, K. R. Neuromonitoring in Otology and Head and Neck Surgery. Raven Press. 1992.

Krass, G.L. and Fisher. R.S. The Johns Hopkins Atlas of Digital EEG: An Interactive Guide. Johns Hopkins Press, 2007.

Kryger., M.H., Roth.T., Dement, W. Principles and Practice of Sleep Medicine, 4th Edition. W. B. Saunders. 2005.

Misulis, K.E., Essentials of Clinical Neurophysiology, 2nd Edition. Butterworth-Heinemann. 1997.

Mizrahi, E.M., Hrachovy, R.A., Kellaway, P. Atlas of Neonatal Electronencephalography, 5th ed. Urban and Schwarzenberg, 2004.

Moller, A. Intraoperative Neurophysiologic Monitoring. Harwood Academic Publishers. 2005.

Nuwer, M.R. (Ed.) Intraoperative Monitoring of Neural Function: Handbook of Clinical Neurophysiology. Elsiver, 2008.

Neidermeyer, E., Da Silva, Fernando. Electroencephalography: Basic Principles, Clinical Applications and Related Fields, 5th edition. Lippincott, Williams & Wilkins. 2005.

Noachtar, S., Wyllie, E. Electroencephalographic Atlas of Epileptiform Abnormalities in the Treatment of Epilepsy: Practice & Principles. 4th Edition., 2006: 183-214.

Pressman, M.R. Primer of Polysomnogram Interpretation. Butterworth-Heinemann. 2002.

Rosenow, F., Luders, O.H. (eds.) Presurgical Assessment of the Epilepsies with Clinical Neurophysiology and Functional Imaging Handbook of Clinical Neurophysiology, Volume 3, Elsevier, 2004.

Russell, G.B., Rodichok. L.D. (eds.) Primer of Intraoperative Neurophysiologic Monitoring. Butterworth-Heinemann, 2005.

Stern, JM.,, Engel, J. Jr. Atlas of EEG Patterns. Lippincott, Williams & Wilkins, 2004

Tatum, W.O., Husain, A.M. Benbadis, S.R., Kaplan, P.W., Handbook of EEG Interpretation. Demos, 2007.

Wyllie, E., Gupta, A., Lachhwani, D.K. (eds.) The Treatment of Epilepsy: Principles and Practice, 4th Ed. Lippincott, Williams & Wilkins, 2006.

Yamada, T., Meng, E. Practical Guide for Clinical Neurophysiologic Testing, Lippincott, Williams & Wilkins, 2009.

Zouridakis, G. & Panpanicolaou, A. A Concise Guide to Intraoperative Monitoring. Lewis, 2000.

Neurophysiologic Intraoperative Monitoring - Track 2 Outline

The NIOM Track will contain more complex multiple-choice questions focused on all aspects of Neurophysiologic Monitoring. Candidates will have three hours to complete 120 items.

  1. Basic NIOM techniques – 25%
    1. SEP
    2. MEP
    3. BAEP
    4. EEG
    5. ECoG
    6. EMG/NCS
    7. VEP
    8. Others
  2. Anatomy and physiology – 15%
    1. Cerebral cortex
    2. Subcortical structures
    3. Brainstem and cerebellum
    4. Ascending and descending pathways
    5. Cranial nerves
    6. Spinal cord
    7. Peripheral nerves, neuromuscular junction, muscles
    8. Vascular anatomy
    9. Head and neck
    10. Spine and other bones
    11. Cellular physiology
    12. Others
  3. Surgical procedures and NIOM (to include surgical technique and NIOM questions) – 25%
    1. Vertebral column surgery
    2. Spinal cord surgery
    3. Lumbosacral surgery
    4. Tethered cord surgery
    5. Peripheral nerve surgery
    6. CPA surgery
    7. Vascular surgery
    8. Cardiac and aortic surgery
    9. Epilepsy surgery
    10. Brain tumor surgery
    11. Posterior fossa decompression surgery
    12. Selective dorsal rhizotomy
    13. Pain surgery
    14. Movement disorders surgery
    15. Cranial nerve surgery
    16. Pelvic floor surgery
    17. Hip surgery
    18. ENT surgery
    19. Other surgery
  4. Anesthetic considerations – 15%
    1. SEP
    2. MEP
    3. BAEP
    4. EEG
    5. ECoG
    6. EMG/NCS
    7. VEP
    8. Anesthesia not modality related
    9. Others
  5. Operating room procedures – 5%
    1. Sterilization techniques
    2. OR equipment
    3. Anesthesia equipment
    4. Aseptic techniques/sterile field
    5. Imaging
    6. Communication
  6. Equipment/Networking issues – 10%
    1. Electrodes
    2. NIOM machines (incl. amplifiers, filters, averaging, electrical issues, etc)
    3. Networking, remote access
    4. Other/Ancillary equipment
  7. Ethical and medicolegal issues – 5%
    1. ACNS guidelines
    2. AANEM guidelines
    3. AAN guidelines
    4. Medicare rules for interpretation
    5. Real time review issues
    6. Other

Epilepsy Monitoring - Track 2 Outline

The Epilepsy Monitoring Track will contain more scenario based items and will incorporate video segments. Candidates will have three hours to complete approximately 120 items.

  1. Correlate interictal EEG with with seizure type - 10%
    1. Partial onset
    2. Secondarily generalized
    3. Primary generalized
      1. Convulsive
      2. Nonconvulsive
  2. Identification of various patterns of ictal onset, propagation, and resolution along with their localizing significance in scalp recordings - 15%
    1. Focal onset seizure
    2. Generalized convulsive seizure
    3. Generalized nonconvulsive seizure
    4. Syndromes
      1. Hypsarrhythmia – electrodecremental seizures
      2. Lennox Gastaut syndrome
      3. Electrical SE during slow sleep
      4. Landau-Kleffner syndrome
    5. Recognition of non-ictal events & patterns
      1. Artifacts
      2. Nonepileptic paroxysmal patterns
    6. Technical aspects
      1. Appropriate recording montages
      2. Activation techniques
      3. Other approaches that may assist in event interpretation
  3. Recognition of clinical manifestations of various seizure types, and their appropriate classification - 20%
    1. Simple partial
    2. Complex partial
      1. Automatisms
      2. Lateralizing signs
      3. Localizing signs
    3. Secondarily generalized
      1. Lateralizing signs
      2. Localizing signs
    4. Primary generalized
      1. Convulsive
      2. Absence
    5. Myoclonic
    6. Atonic
  4. Identification and localization of neonatal seizures - 6%
    1. Interictal EEG patterns
    2. Ictal EEG patterns
      1. Focal
      2. Multifocal
    3. Clinical manifestations
  5. Recognition of behavioral features suggestive of non-epileptic events - 15%
    1. Psychogenic
    2. Arrhythmia
    3. Parasomnia
    4. Other
  6. Planning and Interpretation of Intracranial Monitoring - 12%
    1. Indications for intracranial monitoring
    2. Choice of intracranial electrodes
      1. Subdural strips
      2. Grids
      3. Depth electrodes
    3. Interictal epileptiform activity
    4. Ictal activity
      1. Identification of seizure onset
      2. Localization
  7. Evaluation of patients for epilepsy surgery - 12%
    1. EEG findings leading to
      1. Temporal lobectomy
      2. Corpus callosotomy
      3. Multiple subpial transection
    2. EEG and the intracarotid amobarbital test (Wada)
    3. Intraoperative electrocorticography
      1. Uses
      2. Limitations

Generalist - Track 2 Outline

The Generalist Track will include short segments of neurophysiologic studies (EEG, evoked potentials, etc.), with one or more multiple-choice questions for each sample. Additional multiple choice questions will cover technical aspects of recording and clinical correlation.

  1. Electroencephalography - 40%
    1. Physiology of normal and abnormal waveforms
    2. Instrumentation and acquisition procedures (include quantitative EEG)
    3. Normal patterns of various ages in wake, drowsy, and sleep states
    4. Neonatal normal and abnormal patterns
    5. Activating procedures (hyperventilation, photic stimulation)
    6. Drug effects
    7. Focal abnormalities
    8. Diffuse abnormalities
    9. Coma and brain death
    10. Epileptiform abnormalities
    11. Benign EEG variants and patterns of unknown significance
    12. Artifacts
  2. Epilepsy Monitoring - 15%
    1. Correlate interictal EEG with seizure type / epilepsy syndrome
    2. Localization and propagation of epileptogenic foci (children, adults)
    3. Correlation of behavioral and electrographic changes
    4. Identify and localize neonatal seizures
    5. Nonepileptic events (physiologic and psychogenic)
    6. Plan and interpret intracranial monitoring
    7. Evaluate patients for epilepsy surgery
  3. Evoked Potentials - 15%
    1. Visual evoked potentials (pattern reversal)
    2. Brain stem auditory evoked potentials
    3. Short latency somatosensory evoked potentials
      1. Stimulus and recording techniques
      2. Criteria for identification of major waveform components
      3. Criteria for normal and abnormal evoked potentials for adults and children
      4. Presumed generator sources of major waveform components
      5. Clinical significance of various evoked potential abnormalities
      6. Technical and non-pathologic factors that influence evoked potentials and affect interpretation
  4. Sleep - 15%
    1. Recognition of sleep stages
    2. Identification of examples showing the effects of age, physiological and environmental variables, and disease on sleep architecture
    3. Interpretation of multiple sleep latency studies
    4. Identification of polysomnographic findings in sleep-related disorders
    5. Montages, special instrumentation and other technological aspects of sleep studies
  5. Intraoperative Monitoring - 10%
    1. SEP monitoring for spinal cord, brainstem and cerebral surgery
    2. BAEP monitoring techniques for eighth nerve and brainstem surgery
    3. EEG monitoring for cerebral surgery
    4. Motor evoked potential monitoring for spinal cord surgery
    5. Cranial nerve monitoring
    6. Criteria for decision making
    7. Influence of anesthetic agents

Revised 04/2010