eMedicine Specialties > Emergency Medicine > Neurology

Lambert-Eaton Myasthenic Syndrome: Follow-up

Author: Paul Kleinschmidt, MD, Consulting Staff, Department of Emergency Medicine, Womack Army Medical Center
Contributor Information and Disclosures

Updated: Sep 2, 2009

Follow-up

Further Inpatient Care

  • In patients in whom LEMS is suspected and history suggests acute worsening, admission for observation and testing is warranted.
  • Patients experiencing acute exacerbations of weakness should be admitted for further testing and therapy that is best completed on an in-patient basis.
  • Medical therapy, as previously mentioned, to include immunosuppression and plasmapheresis, may be indicated.

Further Outpatient Care

  • Ideally, the patient's neurologist or primary care physician should coordinate all tests and procedures ordered on an outpatient basis.
  • Physical therapy and exercise are important parts of the outpatient regimen to help maintain muscle tone and strength.

Deterrence/Prevention

  • The ED physician should be aware of medications that can cause deterioration in the patient's condition. These include neuromuscular blocking agents, aminoglycosides, magnesium, iodinated intravenous contrast, and calcium channel blockers.

Complications

  • The most significant complication, and the only one that applies to emergency medicine, is acute respiratory compromise. This is rare and usually is due to iatrogenic reasons (as already discussed).
  • Increased temperatures from fever or the environment also may worsen the weakness.
  • Patients may experience transient worsening following hot baths and showers or during systemic illnesses.

Prognosis

  • The prognosis is difficult to determine since it often is linked with the progression of the underlying cancer.
  • In most cases, therapy with agents such as DAP may help to relieve symptoms partially, but usually symptoms progress over time.
 


More on Lambert-Eaton Myasthenic Syndrome

Overview: Lambert-Eaton Myasthenic Syndrome
Differential Diagnoses & Workup: Lambert-Eaton Myasthenic Syndrome
Treatment & Medication: Lambert-Eaton Myasthenic Syndrome
Follow-up: Lambert-Eaton Myasthenic Syndrome
Multimedia: Lambert-Eaton Myasthenic Syndrome
References
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References

  1. Wirtz PW, Sotodeh M, Nijnuis M, et al. Difference in distribution of muscle weakness between myasthenia gravis and the Lambert-Eaton myasthenic syndrome. J Neurol Neurosurg Psychiatry. Dec 2002;73(6):766-8. [Medline].

  2. Titulaer MJ, Wirtz PW, Willems LN, van Kralingen KW, Smitt PA, Verschuuren JJ. Screening for small-cell lung cancer: a follow-up study of patients with Lambert-Eaton myasthenic syndrome. J Clin Oncol. Sep 10 2008;26(26):4276-81. [Medline].

  3. Illa I. IVIg in myasthenia gravis, Lambert Eaton myasthenic syndrome and inflammatory myopathies: current status. J Neurol. May 2005;252 Suppl 1:I14-8. [Medline].

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  6. Buchwald B, Ahangari R, Weishaupt A, Toyka KV. Presynaptic effects of immunoglobulin G from patients with Lambert-Eaton myasthenic syndrome: their neutralization by intravenous immunoglobulins. Muscle Nerve. Apr 2005;31(4):487-94. [Medline].

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Further Reading

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Keywords

LEMS, neuromuscular transmission, voltage-gated calcium channels, presynaptic motor nerve terminal, Lambert-Eaton myasthenic syndrome, muscle weakness, acetylcholine, ACh, myasthenia gravis

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Contributor Information and Disclosures

Author

Paul Kleinschmidt, MD, Consulting Staff, Department of Emergency Medicine, Womack Army Medical Center
Paul Kleinschmidt, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jerome FX Naradzay, MD, FACEP, Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina
Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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