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Lambert Eaton myasthenic syndrome

Other Names for this Disease
  • Eaton Lambert syndrome
  • Lambert Eaton syndrome
  • LEMS
  • Myasthenic syndrome of Lambert-Eaton
  • Myasthenic-Myopathic syndrome of Lambert-Eaton
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Your Question

My husband has Lambert-Eaton myasthenic syndrome.  We read somewhere that this condition may be caused by an anesthetic.  I'm now unable to locate that information.  Is that true?  If so, what anesthetic?

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What is Lambert Eaton myasthenic syndrome?

Lambert Eaton myasthenic syndrome (LEMS) is a disorder of the neuromuscular junction. The neuromuscular junction is the site where nerve cells meet muscle cells and help activate the muscles.[1] This syndrome occurs when antibodies interfere with electrical impulses between the nerve and muscle cells. It may be associated with other autoimmune diseases, or more commonly coincide with or precede a diagnosis of cancer such as small cell lung cancer. Symptoms may include muscle weakness, a tingling sensation in the affected areas, fatigue, and dry mouth.[1] Treatment of a underlying disorder or cancer is the first priority of treatment.
Last updated: 4/22/2011

What is the connection between Lambert-Eaton myasthenic syndrome and anesthesia?

Lambert-Eaton myasthenic syndrome is caused by an interruption in the nerve to muscle electrical impulses. There are medications that act upon the transmission of these impulses that can worsen symptoms of Lambert-Eaton myasthenic syndrome. There have been cases reported in the literature, where the first symptoms of Lambert-Eaton myasthenic syndrome occurred following administration of such medications.[2] In these instances the medication triggered symptoms of the syndrome that were previously absent or unnoticeable. 

Medications that act upon the transmission of impulses between nerve and muscle cells that may worsen symptoms of Lambert-Eaton myasthenic syndrome, include muscle relaxants (e.g., succinylcholine) that may be used during anesthesia as well as the following drugs:[3]

  • Aminoglycosides antibiotics (e.g., vancomycin, gentamicin)
  • Macrolides antibiotics (e.g., azithromycin, clarithromycin, or erythromycin)
  • b-Lactams
  • Iodinated contrast agents (used in Computed Tomography, plain X-ray and X-ray angiography)
  • Beta-blockers
  • Calcium channel blockers
  • Lidocaine
  • Bretylium
  • Procainamide (e.g., Novocain)
  • d-tubocurarine
  • Quinine
  • Quinidine
  • Procainamide
Last updated: 10/9/2009

What are the symptoms of Lambert-Eaton myasthenic syndrome?

Signs and symptoms of Lambert-Eaton myasthenic syndrome may include:[4]

Weakness or loss of movement that varies in severity:

Vision changes:

  • Blurry vision
  • Double vision
  • Difficulty maintaining a steady gaze

Other symptoms may include blood pressure changes, dizziness upon rising, and dry mouth

Last updated: 10/9/2009

How might Lambert-Eaton myasthenic syndrome be treated?

Medications and therapies used to treat Lambert-Eaton myasthenic syndrome may include anticholinesterase agents (e.g., Pyridostigmine), guanidine hydrochloride, plasmapheresis (where blood plasma is removed and replaced with fluid, protein, or donated plasma) or IV immunoglobulins, steroids (e.g., prednisone), azathioprine or cyclosporine, and/or 3,4-diaminopyridine.[3]

3,4-diaminopyridine is available in Europe and may be available in the U.S. on a compassionate use basis. While there has been some evidence that either 3,4-diaminopyridine or IV immunoglobulin can improve muscle strength and nerve to muscle cell communication, the degree of benefit (i.e., how much symptoms are improved) still needs to be determined.[3]
Last updated: 10/9/2009

What is the prognosis for individuals with Lambert-Eaton myasthenic syndrome?

The prognosis for individuals with LEMS varies. The symptoms of Lambert-Eaton syndrome may improve with treatment of an underlying tumor and/or with suppressing the immune system. However, not all people respond well to treatment.[1][4]
Last updated: 10/9/2009

  • NINDS Lambert-Eaton Myasthenic Syndrome Information Page. Institute of Neurological Disorders and Stroke (NINDS). 2007; Accessed 10/28/2009.
  • Bui PK, Kuczkowski KM, Moeller-Bertram T, Sanchez RA. New onset Lambert-Eaton myasthenic syndrome as an unexpected cause of delayed recovery from general anesthesia after thyroidectomy. Ann Fr Anesth Reanim. 2004 Sep;
  • Stevens RD. Neuromuscular disorders and anesthesia. Curr Opin Anaesthesiol. 2001 Dec;
  • Lambert-Eaton Syndrome. MedlinePlus. 2008; Accessed 10/28/2009.