What is the initial management of Lambert-Eaton myasthenic syndrome (LEMS)?

Updated: May 23, 2019
  • Author: David E Stickler, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
  • Print

Therapy seldom is started in the emergency department (ED). In general, before medical therapy begins, myasthenia gravis (MG) must be excluded. If the diagnosis is in any doubt, further workup or therapy for MG should be considered.

In the ED setting, the most serious threat to life in these patients is the rare cases of respiratory failure. In such cases, treat as in any other patient: initiate supplemental oxygen; secure intravenous (IV) access; and intubate, if indicated. If intubation proves necessary, the use of neuromuscular blocking agents may further exacerbate the weakness and have prolonged effects (see Avoidance of weakness-exacerbating drugs).

Patients experiencing acute exacerbations of weakness should be admitted for further testing and therapy that is best completed on an in-patient basis. Medical therapy, to include immunosuppression and plasmapheresis, may be indicated (see Pharmacologic Therapy and Plasma Exchange).

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!