Smoking cessation
Healthy diet
and adequate hydration
Physical therapy and exercise
Avoidance of increased
temperatures, e.g. hot
showers or baths
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Information in this website is provided to support your understanding of LEMS but is always secondary to the advice of your doctor. Please consult your doctor for diagnosis or treatment of any medical condition.
Medical treatment
If a cancer is found, the first step is to treat the cancer. Successful cancer treatment often helps to alleviate the symptoms of LEMS.1–3 When LEMS is not associated with a cancer, or if treatment of the cancer does not help the symptoms of LEMS, management includes medical treatment and supportive care.1–3 Medical treatment may include medication to improve nerve transmission (symptomatic treatment) and/or therapies to reduce the activity of the immune system (immunosuppressive treatment).1,2
Symptomatic treatment
Symptomatic treatments work by improving the transmission of nerve signals to the muscles and are usually the initial treatment for LEMS. The two main types of symptomatic treatment are cholinesterase inhibitors and aminopyridines.1,3
Aminopyridines
Aminopyridines work by increasing the amount of the neurotransmitter acetylcholine available to transmit messages from the nerves to the muscles.2, 4 These medications can help to improve muscle strength and LEMS symptoms associated with the autonomic nervous system.4,7
Cholinesterase inhibitors
Cholinesterase inhibitors increase the transmission of nerve impulses by preventing the breakdown of the neurotransmitter acetylcholine.8 They can improve muscle strength, but the effect is not as good as in myasthenia gravis. Cholinesterase inhibitors may have an effect on symptoms like dry mouth.3,9
Immunosuppressive treatment
If symptomatic treatment doesn’t help to reduce the symptoms of LEMS, therapies that reduce the activity of the immune system may be recommended. These treatments are most commonly used for LEMS that is not associated with cancer.1,2
Immunoglobulin treatment
Intravenous immunoglobulin (IVIg) works by decreasing the amount of autoantibodies in the blood. It can help to improve muscle weakness in patients with non-cancer-associated LEMS.1,2,5 IVIg is usually used in patients who have severe weakness.3,5
Plasma exchange
Plasma exchange may be considered in people who have severe muscle weakness.3,5 It works by filtering the blood to remove the autoantibodies that attack the nerves.6
Steroids and other immunosuppressants
Steroids and other immunosuppressive drugs are medications that reduce the activity of the immune system.3,5
Supportive care
In addition to medical treatment, other ways to help relieve the symptoms of LEMS, improve comfort or prevent complications may be useful.
Medication to prevent conditions such as
deep vein thrombosis and peptic ulcers
Avoidance of medications
that impair neuromuscular
transmission
Surveillance and
treatment of infections
Lifestyle modifications2,3
Stopping smoking
Healthy diet
and adequate hydration
Physical therapy and exercise
Avoidance of increased
temperatures, e.g. hot
showers or baths
Preventative treatment3
Medication to prevent conditions such as
deep vein thrombosis and peptic ulcers
Medical support2,3
Avoidance of medications
that impair neuromuscular
transmission
Surveillance and
treatment of infections
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References:
1. Tarr TB, Wipf P, Meriney SD. Mol Neurobiol 2015;52(1):456–463. 2. Weimer MB, Wong J. Curr Treat Options Neurol 2009;11(2):77–84. 3. BMJ Best Practice. Lambert-Eaton myasthenic syndrome; management approach http://bestpractice.bmj.com/best-practice/monograph/1052/treatment/step-by-step.html (accessed April 2021). 4. Sanders DB. Ann NY Acad Sci 2003;998:500–508. 5. Seneviratne U and de Silva R. Postgrad Med J 1999;75:516–520. 6. NHS Choices. Lambert-Eaton myasthenic syndrome http://www.nhs.uk/conditions/lambert-eaton-myasthenic-syndrome (accessed June 2017). 7. Tim RW, Massey JM, Sanders DB. L. Neurology. 2000;54(11):2176-8. 8. Mareska M, Gutmann L. Semin Neurol. 2004;24(2):149-53. 9. Wirtz PW, Verschuuren JJ, van Dijk JG, de Kam ML, Schoemaker RC, van Hasselt JG, et al Clin Pharmacol Ther. 2009;86(1):44-8.
1. Tarr TB, Wipf P, Meriney SD. Mol Neurobiol 2015;52(1):456–463. 2. Weimer MB, Wong J. Curr Treat Options Neurol 2009;11(2):77–84. 3. BMJ Best Practice. Lambert-Eaton myasthenic syndrome; management approach http://bestpractice.bmj.com/best-practice/monograph/1052/treatment/step-by-step.html (accessed April 2021). 4. Sanders DB. Ann NY Acad Sci 2003;998:500–508. 5. Seneviratne U and de Silva R. Postgrad Med J 1999;75:516–520. 6. NHS Choices. Lambert-Eaton myasthenic syndrome http://www.nhs.uk/conditions/lambert-eaton-myasthenic-syndrome (accessed June 2017). 7. Tim RW, Massey JM, Sanders DB. L. Neurology. 2000;54(11):2176-8. 8. Mareska M, Gutmann L. Semin Neurol. 2004;24(2):149-53. 9. Wirtz PW, Verschuuren JJ, van Dijk JG, de Kam ML, Schoemaker RC, van Hasselt JG, et al Clin Pharmacol Ther. 2009;86(1):44-8.