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Ophthalmology

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Eyelid

Question
16 out of 17
 

Lambert Eaton syndrome all except (AIPG 2009)



A Spares ocular muscle

B Tensilon test positive

C Proximal muscle involvement

D Repeat nerve stimulation improve muscle strength

Ans. A Spares ocular muscle Ref: Harrison’s 18th Edition, Page 2676

1. LEMS is a presynaptic disorder of the neuromuscular junction that can cause weakness similar to that of MG.

2. The proximal muscles of the lower limbs are most commonly affected, but other muscles may be involved as well.

3. Ptosis of the eyelids and diplopia, occur in up to 70% of patients and resemble features of MG. The two conditions are readily distinguished, since patients with LEMS have depressed or absent reflexes, experience autonomic changes such as dry mouth and impotence, and have incremental rather than decremental responses on repetitive nerve stimulation.

4. LEMS is caused by autoantibodies directed against P/Q type calcium channels at the motor nerve terminals,.

5. These autoantibodies result in impaired release of ACh from nerve terminals.

6. Most patients with LEMS have an associated malignancy, most commonly small cell carcinoma of the lung.

7. Treatment of LEMS involves plasmapheresis and immunosuppression,

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