Palliative care for a patient with Lambert-Eaton myasthenic syndrome: role of 3,4-diaminopyridine

Lambert-Eaton myasthenic syndrome (LEMS) is an uncommon autoimmune idiopathic or paraneoplastic syndrome producing antibodies against voltage presynaptic calcium channels. The clinical features of patients with LEMS are easily fatigability, muscle weakness and autonomic dysfunction (1). Approximately sixty percent in cases LEMS is associated with malignancy, usually a small cell carcinoma (SCC) of lung (2). The cancer can be detected years after the onset of symptoms, so once LEMS diagnosis is established, the search for occult malignancy should be performed periodically. According to previous studies, many patients with LEMS experience remission in both the clinical symptoms of muscle weakness (3,4) and the electrophysiologic abnormalities (5) after successful treatment of lung SCC. However, some of patients might not respond to conventional therapy and eventually require palliative care (PC) service