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Lambert-Eaton Myasthenic Syndrome (LEMS) and Botulinum Toxin

by Carlo Raj, MD
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    Lambert-Eaton myasthenic syndrome. Before we begin, where are you? Once again, neuromuscular junction. Now, once you’re dealing with the neuromuscular junction, then proximal muscles would be affected more so than the distal. Now, this one is even more interesting. The reason I say that is, well, these days are long with recordings, right? And these days are long in general in medicine. But the way that I function is as the day progresses, I get stronger. Why? Well, it’s not that I have Lambert-Eaton myasthenic syndrome, but that’s how that patient is going to be behave. “Doc, I wake up in the morning and I feel like crap.” And then what happens? As the day progresses, I keep getting stronger and stronger and stronger. So, where is my weakness and what’s my problem? The problem is presynaptically. So now, I need you to think about what happens physiologically when you’re trying to release your acetylcholine. You need action potential to then open up the voltage-gated calcium channels. What’s voltage-gated calcium channels? Bring in the calcium and then you have fusion of your acetylcholine vesicles with the presynaptic terminal. You then release acetylcholine and then you buy into your acetylcholine receptors. As the day progresses, the body is going to find a way to release that acetylcholine. Listen, your body is going to find a way to release that acetylcholine, which means what? You have no problem with the receptor, do you? Nope. You don’t have a problem with the receptor. So, acetylcholine will bind to the receptor, and once it does so, then you’re going to elicit an action potential. Seventy five percent have an autonomic symptom, which are frequent. For example, dry eyes, dry mouth, impotence. Interesting. Pupils can be involved, parasympathetic dysfunction, perhaps, because it’s a problem with...

    About the Lecture

    The lecture Lambert-Eaton Myasthenic Syndrome (LEMS) and Botulinum Toxin by Carlo Raj, MD is from the course Polyneuropathy. It contains the following chapters:

    • Lambert-Eaton Myasthenic Syndrome (LEMS)
    • Botulinum Toxin

    Included Quiz Questions

    1. Calcium channels
    2. Mitochondria
    3. Acetylcholine esterase
    4. Acetylcholine receptors
    5. Acetylcholine vesicles
    1. Pupils of the patient will constrict with direct and indirect light reflex appropriately
    2. Patient complaints of dry eyes
    3. Patient occular muscles are rarely involved
    4. Patient deep tendon reflexes are reduced or absent
    5. Patient complains of dry mouth
    1. Positive for anti-SSb antibodies
    2. Dry mouth
    3. Dry eyes
    4. Impotence
    5. Paraneoplastic syndrome
    1. Small cell cancer of lung
    2. Squamous cell cancer of lung
    3. Bronchial carcinoid
    4. Pheochromocytoma
    5. Hodgkins lymphoma
    1. Exposure to Botulinum toxin in utero
    2. Myasthenia gravis
    3. Lambert Eaton Myasthenic syndrome
    4. Tick paralysis
    5. Issac syndrome

    Author of lecture Lambert-Eaton Myasthenic Syndrome (LEMS) and Botulinum Toxin

     Carlo Raj, MD

    Carlo Raj, MD


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