99.3 🩺 內科專科考前版

99.3.0.1 📌 䞀頁重點

  • 22E:
    • Cell surface antibody syndromes (AE): more responsive to immunotherapy than classic intracellular antibody syndromes
    • Anti-IgLON5: sleep + bulbar + brainstem; tau-related; rare
    • Anti-DPPX, anti-GABAB-R, anti-AMPAR expanding
    • ICI-induced neurologic irAE rising; high mortality with myocarditis combo
    • Bispecific T-cell engagers (BiTE) + CAR-T also have neurotoxicity (CRS, ICANS)
  • Taiwan: 健保 anti-Hu/Yo/Ri/Ma2/VGCC + anti-NMDA-R/LGI1/CASPR2 panel 條件; 健保 IVIG, plasma exchange, rituximab, cyclophosphamide; 健保 amifampridine for LEMS 自費

99.3.0.2 🌟 Pearls (10)

  1. Cell surface vs intracellular Ab: surface (NMDA, LGI1) responds well; intracellular (Hu, Yo) poor neuro recovery
  2. Anti-NMDA + ovarian teratoma: tumor removal + immunotherapy → 80% recovery
  3. FBDS (faciobrachial dystonic seizure) = anti-LGI1 pathognomonic
  4. Morvan syndrome (anti-CASPR2): limbic + neuromyotonia + dysautonomia + insomnia
  5. Anti-IgLON5: sleep disorder + brainstem; tau pathology (newer 22E)
  6. HSV encephalitis can trigger anti-NMDA: post-HSV autoimmune encephalitis
  7. PET-CT for occult primary in PNS
  8. Routine cancer screen post-PNS diagnosis: every 3-6 mo for 4 yr (PNS-Care criteria)
  9. ICI myasthenia + myocarditis + myositis combo: severe; treat aggressive
  10. CAR-T + BiTE neurotoxicity (ICANS): tocilizumab + steroid + supportive

99.3.0.3 📍 Taiwan + 健保

  • 健保 onconeural Ab panel + AE panel 條件 (新; 醫孞䞭心)
  • 健保 IVIG (NHIA condition)
  • 健保 plasma exchange 條件
  • 健保 rituximab 條件
  • 健保 cyclophosphamide
  • 健保 high-dose steroid (methylpred, dexa)
  • Amifampridine (Firdapse) for LEMS 自費 倚
  • 健保 antiepileptic (multiple)

99.3.0.4 🎓 內專必懂 (10)

  1. Onconeural Ab spectrum + cancer associations
  2. AE cell surface Ab syndromes
  3. Anti-NMDA-R encephalitis (4-stage progression + ovarian teratoma)
  4. Anti-LGI1 limbic + FBDS + hypoNa
  5. LEMS workup + amifampridine
  6. Stiff person syndrome
  7. ICI neurologic irAE + myocarditis combo
  8. CAR-T / BiTE neurotoxicity (ICANS)
  9. PNS-Care criteria + surveillance
  10. 22E: cell surface paradigm shift, anti-IgLON5, ICI-related, CAR-T expansion

⚠ AI 草皿。