Abstract
Rudnicki described a patient with Lambert-Eaton myasthenic syndrome (LEMS) and small cell lung carcinoma (SCLC) who presented with isolated ocular weakness.1 We agree with the author that this rare presentation of LEMS might be confused with purely ocular seronegative myasthenia. However, we want to stress that the absence of ocular weakness is a more frequent cause of failure to diagnose LEMS. Proximal leg weakness without ptosis or diplopia is frequently not recognized as a neuromuscular transmission disorder. Rudnicki states that the prevalence of ocular symptoms in LEMS shows a wide range (0 to 65%).2,3 However, this is probably due to observer bias. Wirtz et al.2 studied the initial symptoms at disease onset, whereas Burns et al.3 described the symptoms present at diagnosis (median 8 months). …
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