{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T12:44:02Z","timestamp":1785242642626,"version":"3.55.0"},"reference-count":45,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2006,1,24]],"date-time":"2006-01-24T00:00:00Z","timestamp":1138060800000},"content-version":"vor","delay-in-days":876,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Annals of the New York Academy of Sciences"],"published-print":{"date-parts":[[2003,9]]},"abstract":"<jats:p><jats:bold>A<jats:sc>bstract<\/jats:sc>: <\/jats:bold> A high index of suspicion is essential in arriving at the correct diagnosis of Lambert\u2010Eaton myasthenic syndrome (LEMS). LEMS should be considered in the differential in any patient who has proximal weakness, reduced or absent muscle stretch reflexes, and dry mouth. Weakness predominates in hip and shoulder muscles, but may also affect ocular and oropharyngeal muscles to a lesser extent. The diagnosis is confirmed by demonstrating characteristic electromyographic findings\u2014low\u2010amplitude muscle responses that increase dramatically after activation. Most patients also have circulating antibodies to the voltage\u2010gated calcium channel. Half the patients with LEMS have a malignancy, usually small\u2010cell lung cancer. The diagnosis should trigger an intensive search for malignancy, especially in older patients with a history of smoking. Younger, nonsmoking patients are likely to have LEMS as part of a more general autoimmune state. Successful treatment of the underlying cancer leads to improvement in many patients. More than 85% of patients have clinically significant benefit from 3,4\u2010diaminopyridine (DAP). In over half of these, the improvement is marked. If severe weakness persists despite DAP, immunotherapy should be considered. Plasma exchange and high\u2010dose immunoglobulin induce transient improvement in many patients, but function rarely becomes normal. Combinations of prednisone, azathioprine, or cyclosporine have been used with variable success. Improvement, if any, occurs only after many months and requires chronic administration of immunosuppressive medications at significant doses. The long\u2010term prognosis in LEMS is determined by the presence of cancer or other autoimmune disease.<\/jats:p>","DOI":"10.1196\/annals.1254.065","type":"journal-article","created":{"date-parts":[[2004,1,15]],"date-time":"2004-01-15T01:04:15Z","timestamp":1074128655000},"page":"500-508","source":"Crossref","is-referenced-by-count":83,"title":["Lambert\u2010Eaton Myasthenic Syndrome"],"prefix":"10.1111","volume":"998","author":[{"given":"DONALD B.","family":"SANDERS","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,1,24]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410370708"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.4.1143"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-4598(200103)24:3<444::AID-MUS1021>3.0.CO;2-W"},{"key":"e_1_2_9_5_2","unstructured":"Khurana R.K. 1993. 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