Non-paraneoplastic Lambert-Eaton myasthenic syndrome: a brief review of 10 cases

Arq Neuropsiquiatr. 2010 Dec;68(6):849-54. doi: 10.1590/s0004-282x2010000600004.

Abstract

Lambert-Eaton myasthenic syndrome (LEMS) is an immune-mediated disorder of the presynaptic neuromuscular transmission, which more frequently occurs as the remote effect of a neoplasm, in the paraneoplastic form (P-LEMS), or in a non-paraneoplastic form (NP-LEMS); but few studies describe the clinical features of NP-LEMS. We analyzed the clinical manifestations, laboratory findings, electrophysiological studies, and treatment responses in ten Brazilian patients suffering from NP-LEMS. The mean age was 41.5 years. More often neurological findings were hyporeflexia or areflexia with a post-exercise improvement. Treatment response occurred with pyridostigmine, guanidine, prednisone, azathioprine, and cyclosporine; but not response was observed after intravenous immunoglobulin and plasma exchange. Age at onset, clinical manifestations, and electrophysiological abnormalities can help more in the diagnosis than serum antibodies; the symptomatic treatment with pyridostigmine was effective; and the immunosuppressive treatment with prednisone, azathioprine, or cyclosporine was more beneficial than plasma exchange or intravenous immunoglobulin treatment.

MeSH terms

  • Adult
  • Electrophysiology
  • Female
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Lambert-Eaton Myasthenic Syndrome* / diagnosis
  • Lambert-Eaton Myasthenic Syndrome* / physiopathology
  • Lambert-Eaton Myasthenic Syndrome* / therapy
  • Male
  • Middle Aged
  • Plasmapheresis
  • Retrospective Studies

Substances

  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents