Table 4.

Lambert-Eaton Myasthenic Syndrome – Approach to Treatment

Screen for small cell cancer	If cancer detected then aggressive treatment for malignancy may improve or be curative for LEMS
Amifampridine	Begin 5 mg three times per day and gradually increase every 3–4 days by 5 mg.
Pyridostigmine	30–60 mg 3–4 times per day
If insufficient improvement then add immunosuppressant therapy	Prednisone, azathioprine, mycophenolate, etc.
If severe or refractory weakness then add IVIg/PE	IVIg 2 g/kg over 4–5 days then maintenance or plasma exchange
Rituximab