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ORIGINAL ARTICLE
Year : 2015  |  Volume : 11  |  Issue : 5  |  Page : 95-96

Lambert-Eaton myasthenic syndrome in patients with small cell lung cancer: Report of five cases


1 Department of Electromyography, Henan University, Huaihe Hospital, Henan 475000, PR China
2 Department of Electromyography, Zhejiang Province, Taizhou Central Hospital, Taizhou 318000, PR China
3 Department of Respiratory, Henan University, Huaihe Hospital, Henan 475000, PR China
4 Department of Thoracic Surgery, Henan University, Huaihe Hospital, Henan 475000, PR China
5 Department of Electromyography, Shandong Province, Qianfoshan Hospital, Jinan, Shandong 25000, PR China

Date of Web Publication31-Aug-2015

Correspondence Address:
Dr. Min Zhang
Department of Electromyography, Henan University, Huaihe Hospital, 475000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.163853

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 > Abstract 

Objective: To further evaluate the clinical characteristics of small cell lung cancer (SCLC) with Lambert-Eaton syndrome.
Methods: We reviewed the patient database of our hospital from 2001 to 2013 to evaluate and analyze the patients of SCLC with Lambert-Eaton syndrome. The clinical characteristics and prognosis of the patients were analyzed in this retrospective study.
Results: From reviewing our hospital database, we included 5 SCLC patients with Lambert-Eaton syndrome from 202 SCLC subjects with an incidence rate of 2.5%. The median age of the 5 patients was 52 (41-71) with 4 male and 1 female. The myasthenia symptom can be detected in 2-20 months before the pathology confirmation for small cell lung carcinoma.  The general electromyography characteristics of Lambert-Eaton syndrome was reduction in action potential amplitude after repetitive peripheral never stimulation at low frequency and increased amplitude at high frequency.
Conclusion: Lambert-Eaton syndrome was sometimes found in patients with SCLC which was useful for diagnosis of non-small cell lung carcinoma in a relatively early stage.

Keywords: Characteristics, electromyography, Lambert-Eaton myasthenic syndrome, small cell lung cancer


How to cite this article:
Hao Y, Hu J, Zhang Y, Liu W, Lu S, Zhang M. Lambert-Eaton myasthenic syndrome in patients with small cell lung cancer: Report of five cases. J Can Res Ther 2015;11, Suppl S1:95-6

How to cite this URL:
Hao Y, Hu J, Zhang Y, Liu W, Lu S, Zhang M. Lambert-Eaton myasthenic syndrome in patients with small cell lung cancer: Report of five cases. J Can Res Ther [serial online] 2015 [cited 2020 Sep 27];11:95-6. Available from: http://www.cancerjournal.net/text.asp?2015/11/5/95/163853

Yueqiao Hao and Jinmeng Hu contribute equally to this work.



 > Introduction Top


Lambert-Eaton myasthenic syndrome (LEMS), also named Lambert-Eaton syndrome, or Eaton-Lambert syndrome, is a rare autoimmune disorder that is characterized by muscle weakness of the limbs. It is the result of an autoimmune reaction in which antibodies are formed against presynaptic voltage-gated calcium channels (VGCCs), and likely other nerve terminal proteins, in the neuromuscular junction. [1] LEMS can occur as remote effect of a neoplasm, in the paraneoplastic form, usually in association with small-cell lung cancer (SCLC). Generally speaking, LEMS is relatively rare in the general population with an incidence rate of 0.48/million. [2] However, the incidence is on the rising because of its improved recognition by doctors. And it has been reported that about 50% of LEMS patients had a kind of carcinoma. [1] SCLC accounting for 20% of all diagnosed lung cancer is the major type of cancer which occurs in patients with LEMS. Several articles have reported the clinical characteristic and treatment strategy for patients of SCLC with LEMS. We retrospectively analyzed the patient database and found 5 SCLC patients with LEMS. We evaluate the clinical characteristics of SCLC with Lambert-Eaton syndrome in order to enhance the acknowledgement for health providers.


 > Methods Top


We reviewed the patient database of our hospital from 2001 to 2013 to evaluate and analyze the patients of SCLC with Lambert-Eaton syndrome. The clinical characteristics and prognosis of the patients were analyzed in this retrospective study. The general characteristics were recorded by two authors. The general characteristics include age, gender, duration of LEMS before the diagnosis of SCLC, treatment modality, and prognosis.


 > Results Top


The general characteristics of the five cases

From reviewing our hospital database, we included five SCLC patients with Lambert-Eaton syndrome from 202 SCLC subjects with an incidence rate of 2.5%. The median age of the five patients was 52 (41-71) with four male and one female. The myasthenia symptom can be detected in 2-20 months before the pathology confirmation for small cell lung carcinoma [Table 1].
Table 1: The general characteristics of included 5 cases


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The general electromyography characteristics of Lambert-Eaton syndrome

The general electromyography characteristics of Lambert-Eaton syndrome was reduction in action potential amplitude after repetitive peripheral never stimulation at low frequency and increased amplitude at high frequency [Figure 1].
Figure 1: The general electromyography characteristics of Lambert- Eaton syndrome

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Treatment and prognosis

Four of the five patients received chemotherapy or chemoradiation, and one of the patients received operation after diagnosis of SCLC. The prognosis was recorded in three patients with two symptoms improved, two not available, and one died of multiple metastases.


 > Discussion Top


LEMS is a rare autoimmune disorder of neuromuscular transmission. It is characterized clinically by muscle weakness, hyporeflexia or areflexia, and autonomic dysfunction. LEMS develops as a result of antibodies directed at the presynaptic VGCC. [3],[4] LEMS was firstly reported by Anderson et al. in the year 1953. [5] In that report, they described a 47-year-old man with progressive muscle weakness and diminished tendon reflexes. They found a tumor in patient's lung, which was surgically removed. The tumor was pathology diagnosis of SCLC. After the operation, the muscle weakness symptom was significantly improved. Several years after, American neurologists named Lambert-Eaton described six similar cases with a distinctive electrophysiological pattern seen with repetitive nerve stimulation. [6] Thereafter, this syndrome, with or without SCLC, has become known as LEMS, and the diagnosis is still based on these electrophysiological criteria. [7],[8]

In our retrospective study, we reviewed the patient database of our hospital from 2001 to 2013 and found five typical cases of SCLC with LEMS. The incidence of LEMS in small cell cancer patients was 2.5% which is smaller than the previous studies reported. [2],[9] The general treatment modality for SCLC patients with LEMS was chemotherapy. After chemotherapy, most of the cases had symptom relief. In this study, two patients received chemotherapy, but the prognosis was not available. Two patients received chemoradiation with improved symptom, and one died of multiple metastases. Because of a smaller number of cases in this study, the prognosis of small cell cancer patients with or without LEMS was not compared. Hence, whether LEMS is associated with the prognosis of small lung cancer is not clear.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Titulaer MJ, Maddison P, Sont JK, Wirtz PW, Hilton-Jones D, Klooster R, et al. Clinical Dutch-English Lambert-Eaton Myasthenic syndrome (LEMS) tumor association prediction score accurately predicts small-cell lung cancer in the LEMS. J Clin Oncol 2011;29:902-8.  Back to cited text no. 1
    
2.
Wirtz PW, Nijnuis MG, Sotodeh M, Willems LN, Brahim JJ, Putter H, et al. The epidemiology of myasthenia gravis, Lambert-Eaton myasthenic syndrome and their associated tumours in the northern part of the province of South Holland. J Neurol 2003;250:698-701.  Back to cited text no. 2
    
3.
D′Amour M, Gariepy G, Braidy J. Lambert-Eaton myasthenic syndrome. CMAJ 2007;176:37.  Back to cited text no. 3
    
4.
Seneviratne U, de Silva R. Lambert-Eaton myasthenic syndrome. Postgrad Med J 1999;75:516-20.  Back to cited text no. 4
    
5.
Anderson HJ, Churchill-Davidson HC, Richardson AT. Bronchial neoplasm with myasthenia; prolonged apnoea after administration of succinylcholine. Lancet 1953;265:1291-3.  Back to cited text no. 5
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6.
Lambert EH, Eaton LM, Rooke ED. Defect of neuromuscular conduction associated with malignant neoplasms. Am J Physiol 1956;187:612-3.  Back to cited text no. 6
    
7.
Titulaer MJ, Lang B, Verschuuren JJ. Lambert-Eaton myasthenic syndrome: From clinical characteristics to therapeutic strategies. Lancet Neurol 2011;10:1098-107.  Back to cited text no. 7
    
8.
Maddison P, Lang B, Mills K, Newsom-Davis J. Long term outcome in Lambert-Eaton myasthenic syndrome without lung cancer. J Neurol Neurosurg Psychiatry 2001;70:212-7.  Back to cited text no. 8
    
9.
Ray S, Sonthalia N, Kundu S, Maitra S, Saha M, Talukdar A. Lambert-Eaton myasthenic syndrome and solitary cerebellar metastasis in a patient with occult small-cell lung cancer: A rare experience. BMJ Case Rep 2012;2012. pii: bcr1220115280.  Back to cited text no. 9
    


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