DABNM EXAM OUTLINE

DABNM Examination

Test Weighting:

EXAM CONTENT OUTLINE

I. BASIC NEUROSCIENCE......................................... 20%

II. SIGNAL ACQUISTION AND PROCESSING ............... 5%

III. ELECTROENCEPHALOGRAPHY (EEG) ......................5%

IV. SENSORY EVOKED POTENTIALS ...........................30%

V. MOTOR POTENTIALS ............................................30%

VI. EFFECTS OF ANESTHESIA .................................... 10%

ANESTHESIA

EEG

EEG for Aneurysms and AVMs

EEG for Cardiac Surgery

EEG for CEA Surgery

Motor Systems

Sensory Modalities

signal acquisition processing

SSEPs

I. BASIC NEUROSCIENCE 20%

A. Neuroanatomy

1. Neural Pathways

a. Sensory Modalities and Pathways

b. Motor Pathways

c. Other

2. Peripheral Nerve

a. Plexi

b. Nerve Roots

3. Spine

a. Bony Structures

b. Ascending Tracts

c. Motor Tracts

d. Spinal Circulations

e. Cauda Equina

f. Dermatomal Distribution

g. Myotomes

h. Spinal Cord

4. Brainstem

a. Vascular Anatomy

b. Neuroanatomy

5. Cerebral Hemispheres

a. Primary Motor Area

b. Primary Sensory Area

c. Vascularity

1. Internal Carotid Artery

2. Circle of Willis

3. Anterior Cerebral Artery

4. Middle Cerebral Artery

5. Posterior Cerebral Artery

d. Association Cortex

6. Cranial Nerves Pathways and Function

7. Ear/Auditory Pathway

8. Eye/Optic Pathway

9. Muscles

10. Blood Supply

a. Cortex

b. Brainstem

c. Spinal Cord

11. Skull

B. Neurophysiology

1. Membrane Electrical Potential

2. Propagated Neural Activity

3. Synaptic Transmission

4. Reflexes

II. SIGNAL ACQUISITION AND PROCESSING 5%

A. Basic Electrical Concepts

B. Recording and Stimulation Technique

1. Artifact/Noise

2. Electrodes

3. Amplifiers

4. Filtration

    a. Analog Filters

    b. Digital Filters

    c. 60 Hz Notch Filter

5. Averager Technology

6. Data Storage and Record Keeping

7. Medical Legal Records

    a. Chart Documentation

    b. Consent Forms

    C. Safety Issues

    D. Troubleshooting

    E. Transcranial Doppler

III. ELECTROENCEPHALOGRAPHY (EEG) 5%

A. Generators

B. Interpretation

C. Classification of Frequency

D. Recognition of Patterns

    1. Electrocerebral Silence

    2. Alpha Rhythm

    3. Burst-Suppression

    4. Seizure Activity

    5. Ischemia

    6. Hyperthermia/Hypothermia

    7. Changes in Ventilation

    8. Artifact

E. Recording Montages

F. Methods of EEG Processing

    1. Fourier Series Analysis

    2. Bispectral Array

    3. Mapping Techniques

G. Electrocorticography

H. Functional Mapping

    1. Sensory

    2. Motor

    3. Subcortical

I. Surgical Procedures

    1. Carotid Endarterectomy

    2. Seizure Surgery

    3. Cardiac Surgery

    4. Deliberate Hypothermia

    5. Deliberate Hypotension

    6. Barbiturate Coma

    7. Intracranial Vascular Procedures

IV. SENSORY EVOKED POTENTIALS 30%

A. Somatosensory Evoked Potentials

1. Stimulation

a. Peripheral Nerve

b. Spinal Cord

2. Monitoring Technique

a. Recording Montages

b. Recording Parameters

c. Peak Identification and Correlation with Neural Generators

3. Surgical Procedures

a. Cerebrovascular

b. Identification of Central Sulcus

c. Brainstem Procedures

d. Extracranial Vascular

e. Spinal

f. Peripheral Nerve

g. Other

4. Nonsurgical Factors

a. Temperature

b. Blood Pressure

c. Cerebral Blood Flow

d. Intracranial Pressure

e. Oxygenation

f. Patient Positioning

B. Brainstem Auditory Evoked Potentials

1. Stimulation

2. Monitoring Technique

a. Recording Montages

1. Noninvasive

2. Invasive Techniques

b. Recording Parameters

c. Peak Identification and Neural Generators

3. Surgical Procedures Where Used

a. Cerebellopontine Angle Tumors

b. Microvascular Decompression

c. Vestibular Neurectomy

d. Brainstem Procedures

e. Other

4. Nonsurgical Factors

a. Middle Ear Pressure

b. Fluid from mastoid

c. Temperature

d. Blood Pressure

e. Intracranial Pressure

f. Oxygenation

g. Other

V. MOTOR POTENTIALS 30%

A. Cranial Motor Nerve Monitoring

1. Stimulation

a. Electrical

b. Nonelectrical

2. Monitoring Techniques

a. Recording Montages

b. Recording Parameters

c. Identification of Specific Cranial Nerves

3. Surgical Procedures

a. Skull Base Tumors

b. Other

B. Central Motor Evoked Potentials

1. Stimulation

a. Transcranial Electric

b. Transcranial Magnetic

c. Spinal Cord Stimulation

d . Direct Cortical Stimulation

2. Monitoring Techniques

a. Recording Montages

b. Recording Parameters

c. Peak Identification and Neural Generators

3. Surgical Procedures

a. Spine

b. Other

C. Peripheral Nerve System

1. Stimulation

2. Monitoring Techniques

a. Recording Montages

b. Recording Parameters

3. Surgical Procedures

a. Pedicle Screws

b. Dorsal Rhizotomy

c. Peripheral Nerve

d. Brachial Plexus

e. Other

4. Nonsurgical Factors

a. Temperature

b. Tourniquet

VI. EFFECTS OF ANESTHESIA 10%

A. Agents

1. Inhalational

a. Halogenated

b. Nitrous Oxide

2. Intravenous

a. Opioids

b. Sedatives-Hypnotics

3. Muscle Relaxants

4. Regional Anesthesia

5. Formulas for Dosage

B. Differential Effects on Anatomic Structures

1. Muscle

2. Neuromuscular Junction

3. Peripheral Nerve

4. Spinal Cord

5. Brainstem

6. Cortex

C. Anesthetic Techniques

1. Suitable for Various Recordings

a. Cortical Recording

b. Subcortical Recording

c. Muscle Action Potential Recording

d. Cortical Stimulation Techniques

e. Direct Cortical Stimulation

f. Transcutaneous Motor Stimulation

2. Wake Up Test

3. Management of Neuromuscular Block

4. Patient Positioning

D. Physiological Factors

1. Temperature

2. Metabolites, Electrolytes

3. Intracranial Pressure

4. Oxygenation

5. Blood Pressure/Perfusion

6. Ventilation

Other than these suggestions, the ABNM currently does not endorse any particular review course or study guides. Further, other than reviewing the publicly available material (such as this information sheet), the active directors of the ABNM Board have agreed to refrain from participating in courses specifically designed to review or prepare for the examination. Individuals who have taken the written examination have made the following comments. Individuals typically used all of the time available. When asked about giving advice for studying for the examination these individuals suggested the following.

Particularly helpful texts were Desmedt and Chiappa for basic electrophysiology.

Review basic neuroanatomy, especially the cranial nerves.

For this, the works by Netter were recommended.

Review Marc Nuwer's book for basic technology and recording methodology and review

Aage Moller's book for auditory monitoring.

Review the Journal of Clinical Neurophysiology for current reviews as well as examine the current material presented at up-todate meetings (such as the annual ASNM meeting) was helpful and in line with the material on the exams.

http://www.ptcny.com/PDF/ABNM.pdf

Textbooks (alphabetical order by author):

1. M. J. Aminoff, Electrodiagnosis in Clinical Neurology, 5th Edition, Elsevier, 2005.

2. D.L. Beck, Handbook of Intraoperative Monitoring, Singular Publishing Group, Inc., 1994.

3. E.E. Benarroch Medical Neurosciences: An Approach to Anatomy, Pathology, and Physiology by Systems and Levels, 4th Edition, Lippincott Williams & Wilkins Publishers, 1998.

4. K. K. Chiappa Evoked Potentials in Clinical Medicine, Lippincott Williams & Wilkins, 3rd Edition, 1997.

5. D.D. Daly, T.A. Pedley, Current Practice of Clinical Electroencephalography, 2nd edition, Raven Press, 1990.

6. V. Deletis, J. Shils, Neurophysiology in Neurosurgery. A Modern Intraoperative Approach, Academic Press, 2002.

7. JE Desmedt, Neuromonitoring in Surgery (Clinical Neurophysiology Updates, Volume 1, Elsevier Science Ltd., 1989.

8. J. Engel, Surgical Treatment of the Epilepsies, 2nd Edition, Raven Press, 1993.

9. R.H. Gelberman, Operative Nerve Repair and Reconstruction, Lippincott Raven, 1991.

10. B.L. Grundy, RM Villani, Evoked Potentials: Intraoperative and ICU Monitoring, Springer Verlag, 1988.

11. E.R. Kandel, J.H. Schwartz, T.M. Jessell, Principles of Neural Science, 4th Edition, McGraw-Hill, 2000.

12. C.M. Loftus, V.C. Traynelis, Intraoperative Monitoring Techniques in Neurosurgery, McGraw-Hill, 1994.

13. K.F. Misulis, Spehlmann’s Evoked Potential Primer, 3rd Edition, Butterworth-Heinemann, 2001.

14. A. Möller, Intraoperative Neurophysiological Monitoring, Second Edition, Humana Press, 2006.

15. E. Niedermeyer, F.L. Da Silva, Electroencephalography: Basic Principles, Clinical Applications and Related Fields, 5th Edition, Lippincott, Williams and Wilkins, 2005.

16. M.R. Nuwer, Intraoperative Monitoring of Neural Function, Elsevier Press, 2008.

17. G.B. Russell, L.D. Rodichok, Primer of Intraoperative Neurophysiologic Monitoring, Butterworth-Heinemann Press, 1995.

18. B.F. Westmoreland and E.E. Benarroch, Medical Neurosciences: An Approach to Anatomy, Pathology and Physiology by Systems and Levels, 3rd Edition, Lippincott Williams and Wilkins, 1994.

19. L. Wilson-Pauwels, PA Stewart, E.J. Akesson, Cranial Nerves, BC Decker, Inc., 1998.

20. G. Zouridakis, A.C. Papanicolaou, A Concise Guide to Intraoperative Monitoring, CRC Press, 2001.

Suggested Journals (alphabetical order):

1. American Journal of Otology

2. Clinical Neurophysiology

3. Journal of Clinical Neurophysiology

4. Journal of Neurophysiology

5. Journal of Neuroscience

6. Journal of Neurosurgery

7. Neurosurgery

8. Spine

9. Spine Journal

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