Benchmarking Large Language Models on the Taiwan Neurology Board Examinations (2018–2024): A Comparative Evaluation of GPT-4o, GPT-o1, DeepSeek-V3, and DeepSeek-R1

<b>Background and Purpose:</b> Neurology requires integration of clinical reasoning, imaging interpretation, and current knowledge, making it an ideal field for evaluating large language models (LLMs). <b>Methods:</b> Using 1715 questions from the Taiwan Neurology Board Examination (2018-2024), we assessed four LLMs-GPT-4o, GPT-o1, DeepSeek-V3, and DeepSeek-R1-across four formats: single-choice, multiple-choice, true-false, and image-based items. <b>Results:</b> GPT-o1 achieved the highest overall accuracy (83.86%) and demonstrated strong performance on cognitively demanding tasks (82.50% on true-false; 77.26% on image-based). DeepSeek-V3 scored lowest (65.62%) and showed the greatest variability. Statistical analyses confirmed significant inter-model differences (<i>p</i> < 0.01). Accuracy declined across all models in 2024, coinciding with shifts in question design. DeepSeek-R1 was further penalized by alignment-based refusals, resulting in up to 3.81% score loss. <b>Conclusions:</b> These results position the Taiwan Neurology Board Exam as a rigorous benchmark for LLM evaluation and underscore GPT-o1's potential utility in neurology education and decision support.