Abstract
A 65-year old man on treatment for ischaemic heart disease presented with a history of pain and weakness of all four limbs and dry mouth. He had clinical and neurophysiological features of Lambert-Eaton myasthenic syndrome. His symptoms improved after withdrawal of diltiazem, although neurophysiological changes remained even after 3 months.
Highlights
Facilitation) and reduced to 21% after rest (Figure 1)
Lambert–Eaton myasthenic syndrome is an uncommon disorder of the neuromuscular junction, caused by antibodies against voltage-gated calcium channels (VGCC) of the presynaptic nerve endings
The commonly encountered carcinoma is the small cell carcinoma of the lung (SCLC) which accounts to about 60% of the cases, while lymphoproliferative disorders, carcinoma of the breast, colon, pancreas, prostate are rare associations [1]
Summary
Facilitation) and reduced to 21% after rest (Figure 1). Repetitive stimulation of the median nerve at 3 Hz did not show a significant change; at 20 Hz a decrement was shown while at 50 Hz a more than 300% increment response was seen (Figure 2). Edrophonium test was positive with improvement of proximal muscle power with the drug but not with placebo. Stimulation of the right median nerve yielded a compound muscle action potential (CMAP) with small amplitude, which increased by > 200% after isometric stimulation Ceylon Medical Journal improvement in symptoms after its withdrawal and normal CPK, lovastatin was reintroduced.
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