IVIG treatment in non-paraneoplastic Lambert- Eaton myasthenic syndrome with elevated voltage- gated calcium channels antibodies and subacute cerebellar ataxia

Abstract

Non paraneoplastic Lambert Eaton myasthenic syndrome (LEMS) is rare and only very few cases have been reported to date. Besides that, LEMS is rarely associated with cerebellar ataxia. Here, we described a case of middle age gentleman who presented with subacute onset of cerebellar ataxia and subsequently found to have remarkably elevated voltage-gated calcium channels (VGCC) antibodies serum titre and LEMS. Repeated screenings for malignancies remained negative. He improved significantly with intravenous immunoglobulin (IVIG) treatment. In conclusion, even with negative malignancy screen, investigation for LEMS and measurement of VGCC level should be considered in patients with subacute cerebellar ataxia. Our case demonstrated good initial response towards IVIG treatment and hence early and timely initiation of treatment with IVIG may lead to clinical improvement. However, more clinical trials will be required in the future to further determine the long term prognosis of non-paraneoplastic cerebellar ataxia and LEMS towards IVIG treatment.