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NEUROLOGY 1984;34:480
© 1984 American Academy of Neurology

Plasma exchange and immunosuppressive drug treatment in the Lambert-Eaton myasthenic syndrome

John Newsom-Davis, MD, FRCP and Nicholas MF Murray, MB, MRCP

From the Institute of Neurology, National Hospital for Nervous Diseases, Queen Square, London, England.

We undertook serial clinical and electromyographic muscle action potential (MAP) amplitude assessments in nine patients with the Lambert-Eaton myasthenic syndrome (LEMS) over 0.5 to 2.5 years who received plasma exchange (PE; 5 to 15 exchanges over 4 to 19 days) and immunosuppressive drug (IS) treatment (prednisolone 60 to 100 mg on alternate days, azathioprine 2.5 mg/kg for 0.5 to 2.5 years), and who had no signs of carcinoma at entry. Eight patients responded to PE. The peak MAP response occurred 10 to 15 days post-PE, representing a 2.5-fold mean increase and was significant < 0.01). Two of three patients who developed carcinoma responded initially to IS. Three of six noncarcinoma patients developed sustained clinical and MAP remission after 0.5 to 1 year; the three others, of whom two were intolerant of azathioprine, improved. IS and PE may benefit LEMS patients, but caution is required when carcinoma risk is high.

Address correspondence and reprint requests to Prof. Newsom-Davis, Department of Neurological Sciences, Royal Free Hospital School of Medicine, Rowland Hill Street, London, NW3 ZQC, England.

This work was supported by the Medical Research Council.

Accepted for publication July 20, 1983.




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