The Neurology Boards
The ABPN Initial Certification Examination in Neurology — what to expect, what’s tested, the high-yield topics by category, and how to build a plan that gets you across the line.
Certification is granted by the American Board of Psychiatry and Neurology (ABPN). The Initial Certification Examination assesses the knowledge and clinical reasoning needed for high-quality patient care.
It’s a single, computer-based test at Pearson VUE centers, scored pass/fail against a fixed standard (criterion-referenced — no predefined passing rate). The blueprint is 80% adult and 20% child neurology.
Exam format
Questions, 8 sections
Four stand-alone MCQ sections (60–67 Q each) alternate with four linked-item sets (33–40 Q) built around a shared case via text, audio, or a 1–5 min video.
Total testing time
~430 minutes: a short tutorial, 7 hours of questions, and a survey — with up to 50 min pooled break time (lunch included) you spend as you choose.
Computer-based
Delivered at a Pearson VUE center. Unscored pretest questions are embedded and there’s no penalty for guessing — answer everything.
Pass / fail
Scored on a total standard (scaled) score against a fixed criterion; you also get a graphic diagnostic report by subtopic.
First-time pass rate
ABPN’s 5-year aggregate for first-time takers (roughly 81–84% year to year) — very passable with focused, blueprint-aligned prep.
Who can sit
PGY-1 year + 3 years of ACGME-accredited neurology residency, 5 clinical-skills (NEX) evaluations, and an active unrestricted license. Final-year residents apply for that fall’s exam.
What a board score report looks like
Your result is a standard score against a fixed passing bar, shown on a bell curve versus the first-time-taker mean — plus a performance profile by category.
⤢ ExpandDisorders & topics
Share of the exam by disorder (ABPN specifications, posted Dec 2025). The top five are the highest-yield.
ABPN Neurology certification exam: content outline
400 questions: 80% adult and 20% child neurology. Eighteen disorder and topic domains, published as ranges, so they do not add up to exactly 100%. Each box also shows the range on the child neurology certification exam.
Subtopics condensed from the second-level headings of the ABPN content specifications (December 2025); the official outline goes several levels deeper.
Headache and pain disorders — 4–6%
- Primary headaches (migraine, tension-type, cluster, TACs)
- Secondary headaches (trauma, vascular, nonvascular intracranial, infection, substance)
- Headache or facial pain from cranium, neck, eyes, ENT, teeth
- Cranial neuralgias and central or primary facial pain
- Central pain syndromes
- Complex regional pain syndromes
Epilepsy and episodic disorders — 8–12%
- Generalized seizures (tonic-clonic, absence, myoclonic, atonic, spasms)
- Focal seizures
- Electroclinical syndromes by age (neonatal, infancy, childhood, adolescent)
- Less specific age relationship syndromes
- Epilepsies from structural-metabolic causes
- Unknown whether focal or generalized
- Conditions with seizures not traditionally called epilepsy
- Nonepileptic paroxysmal disorders
Sleep disorders — 3–5%
- Insomnia
- Sleep-disordered breathing
- Central disorders of hypersomnolence
- Circadian rhythm sleep-wake disorders
- Parasomnias
- Sleep-related movement disorders
Genetic and developmental disorders — 6–8%
- Heritable disorders of metabolism
- Chromosomal disorders
- Sporadic, gene-related disorders
- Developmental disorders of skull and brain structure
- Neurocutaneous syndromes
- Cerebral palsy
- Teratogens
- Multiple congenital anomalies
Vascular neurology — 8–12%
- Ischemic stroke and TIA
- Intracerebral hemorrhage
- Subarachnoid hemorrhage
- Cerebral venous thrombosis
- RCVS and PRES
- Unruptured aneurysm or vascular malformation; dural fistulas
- CADASIL, sickle cell disease, stroke genetics
- Cardiovascular diseases and prothrombotic causes of stroke
- Hypoxic-ischemic encephalopathy
Neuromuscular diseases — 9–13%
- Motor neuron disorders
- Spinal root disorders
- Plexopathies
- Peripheral nerve disorders
- Neuromuscular junction disorders
- Muscle disorders
- Hyperexcitability disorders
- Autonomic dysfunction in neuromuscular disease
Movement disorders — 8–12%
- Parkinson disease and parkinsonism
- Tremor
- Chorea, ballism, and athetosis
- Dystonia
- Wilson disease and neuroleptic-induced syndromes
- Tic disorders
- Myoclonus and other paroxysmal disorders
- Ataxia
- Functional movement disorders
Demyelinating diseases — 7–11%
- Multiple sclerosis and variants
- Neuromyelitis optica
- ADEM and variants
- Transverse myelitis
Neuroinfectious diseases — 2–4%
- Bacterial infections (meningitis, abscess, congenital)
- Fungal infections
- Mycobacteria, including tuberculosis
- Viral infections
- Protozoan and parasitic infections
- Prion infections
- Noninfectious causes of meningitis
- Systemic infections with neurologic effects
Brain and spinal trauma and spinal diseases — 2–4%
- Brain trauma
- Spinal trauma
- Nontraumatic spinal cord disorders
- Abusive head trauma
- Myeloneuropathy
Neuro-ophthalmologic and neuro-otologic disorders — 2–4%
- Optic nerve, retina, and optic pathway disorders
- Pupil disorders
- Ocular motility disorders
- Intraocular manifestations of stroke
- Vestibular disease
- Hearing loss
- Carotid body tumors (paragangliomas)
Metabolic diseases, nutritional deficiency states, and disorders due to toxins, drugs, and physical agents — 3–5%
- Metabolic diseases
- Nutritional deficiency states
- Toxins, drugs, and physical agents (including metals, carbon monoxide)
- Iatrogenic and therapeutic drug effects
Neuro-oncologic disorders — 1–3%
- Neoplasms
- Hereditary tumor syndromes
- Nonmetastatic neurologic complications of systemic cancer
- Neurologic complications of cancer treatment
Behavioral neurology and neurocognitive disorders — 7–9%
- Delirium, dementia, and other cognitive disorders
- Neurodevelopmental disorders
- Higher cortical function and clinical syndromes
- Altered mental status, encephalopathy, coma, brain death
- Pseudobulbar affect
Psychiatric disorders — 5–7%
- Schizophrenia and other psychotic disorders
- Depressive disorders
- Bipolar and related disorders
- Anxiety disorders
- Obsessive-compulsive and related disorders
- Somatic symptom and related disorders
- Trauma- and stressor-related disorders
- Feeding, eating, and elimination disorders
- Personality and neurobehavioral disorders
Autonomic nervous system disorders — 1–2%
- Disorders of orthostatic tolerance
- Autonomic dysfunction in CNS disorders
- Disorders of sweating and thermoregulation
- Urogenital autonomic disorders
- Gastrointestinal autonomic disorders
- Visceral sensory disorders
Questions not associated with a specific neurologic disorder — 1–3%
- Normal anatomy, process, neurophysiology
- Pharmacology
- Medical-legal, policy, regulatory, professional practice
- Development through the life cycle
- Procedures and procedural safety
- Normal test results, variants, artifacts, methods
Neuroimmunologic and paraneoplastic CNS disorders — 1–3%
- Primary CNS angiitis and secondary CNS vasculitis
- Microangiopathies (Susac, Sneddon)
- Paraneoplastic cerebellar syndromes
- Autoimmune and paraneoplastic encephalitis
- Opsoclonus-myoclonus
- Paraneoplastic epilepsy
Every question also maps to a competency: neuroscience and mechanism of disease 22–28%, clinical aspects 17–23%, diagnostic procedures 17–23%, treatment and management 22–28%, and 2–3% each for interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.
Source: ABPN Neurology content specifications (December 2025)
Competencies & mechanisms
High-weight (17–28% each)
- Neuroscience & mechanism of disease — 22–28%
- Treatment / management — 22–28%
- Clinical aspects of neurologic disease — 17–23%
- Diagnostic procedures — 17–23%
Lower-weight (2–3% each)
- Interpersonal & communication skills
- Professionalism
- Practice-based learning & improvement
- Systems-based practice
High-yield topics by category
The must-know topics inside each of the five highest-weight categories.
- ALS & motor neuron disease
- Myasthenia gravis
- GBS / CIDP
- CMT & hereditary neuropathies
- Muscular dystrophies
- Inflammatory myopathies
- Channelopathies
- Seizure classification
- Epilepsy syndromes
- Status epilepticus
- AED mechanisms & side effects
- EEG patterns
- Pediatric epilepsies
- Stroke mechanisms (TOAST)
- tPA & thrombectomy
- ICH management
- SAH & aneurysms
- Cerebral venous thrombosis
- Secondary prevention
- Parkinson disease
- Atypical parkinsonism (MSA, PSP, CBD)
- Huntington disease
- Dystonia
- Essential tremor
- Drug-induced movement disorders
- Multiple sclerosis
- NMO / NMOSD
- ADEM
- Transverse myelitis
- DMTs & mechanisms
- Neuroanatomy: cortex, basal ganglia, brainstem, cranial nerves, cord, vascular territories
- Neurophysiology: membrane & synaptic transmission, cerebellum, sleep
- Neuropathology: reaction patterns, disease-specific
- Neurochemistry: neurotransmitters, ion channels, BBB
- Neurogenetics: inheritance, repeat disorders, channelopathies
Study strategy
Application & exam dates
Applications open early in the year; the exam is given the following fall. Confirm every date in the ABPN Physician Portal.
Next cycle dates not yet published. Check the official website.
Staying certified
Continuing Certification (CC)
- Every 3-year block: 90 Category-1 CME (including self-assessment).
- 16 Self-Assessment CME credits (recently reduced from 24).
- 1 Performance-in-Practice (PIP) unit + a one-time Patient Safety activity.
- Maintain a full, unrestricted license, pay the annual fee, and attest.
Knowledge assessment — two paths
- ABCC (article-based): ~20 article exams per 3-year cycle (about 6–7/yr) — no big exam.
- Traditional 10-year exam: pass a CC exam at least once every 10 years instead.
- Either satisfies the requirement; most diplomates now choose ABCC.
Prepare the way the boards test
Blueprint-aligned questions
1,400+ board-style questions mapped to the ABPN content areas — practice in proportion to what’s tested.
Percentile tracking
My Progress shows accuracy and percentile by specialty so you know exactly when you’ve crossed the line.
Basic-science coverage
Study notes and flashcards on neuroanatomy, mechanisms and pathology — the quarter of the exam most residents underprep.
Board exams by country
Start your board prep today
Practice questions mapped to the ABPN blueprint, with percentile tracking so you know when you’re ready.
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