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Postexercise reflex facilitation in Lambert-Eaton myasthenic syndrome
  1. Mervyn Poh1,
  2. Yeo Chong Ming2,
  3. Patricia Cheong Yanni2,
  4. Gee Jin Ng1,
  5. Yong Howe Ho3,
  6. Kalpana Prasad1,
  7. Umapathi Thirugnanam1
  1. 1Department of Neurology, Tan Tock Seng Campus, National Neuroscience Institute, Singapore
  2. 2Department of Medical Oncology, Tan Tock Seng Hospital, Singapore
  3. 3Department of Pathology, Tan Tock Seng Hospital, Singapore
  1. Correspondence to Dr Mervyn Poh, Department of Neurology, Tan Tock Seng Campus, National Neuroscience Institute, Singapore; mervyn.poh{at}gmail.com

Abstract

A 62-year-old woman had 6 months of proximal weakness, fatigue and occasional diplopia, symptoms normally suggesting myasthenia gravis or inflammatory myopathy. Postexercise reflex facilitation is a bedside clinical sign that points to a diagnosis of the rarer alternative, Lambert-Eaton myasthenic syndrome (LEMS). We confirmed this diagnosis using electrodiagnostic short exercise testing and serum assay for voltage-gated calcium channel antibodies. Further investigation identified a small cell neuroendocrine carcinoma of the gallbladder, not previously associated with LEMS. Postexercise reflex facilitation is an important bedside clinical finding that helps clinicians to distinguish LEMS from its mimics.

  • LAMBERT EATON SYNDROME
  • PARANEOPLASTIC SYNDROME

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors MP, writing and conceptualisation of the manuscript.YCM, writing of the manuscript. PCY, writing of the manuscript. YHH, writing of the manuscript. GJN, writing of the manuscript. KP, writing of the manuscript. UT, writing and conceptualisation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed by Jon Walters, Swansea, UK.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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