Neurogenic bladder in Lambert-Eaton myasthenic syndrome and its response to 3,4-diaminopyridine

Autonomic dysfunction, as well as neuromuscular involvement, is a common ma nifestation of Lambert-Eaton myasthenic syndrome (LEMS). Dry mouth and impo tence have been described as typical features of autonomic dysfunction, but neurogenic bladder is infrequent or subclinical in LEMS. We report a patie nt with neurogenic bladder secondary to LEMS whose condition responded to 3 ,4-diaminopyridine (3,4-DAP). In this patient's serum, results of repeated measurement with P/Q-type VGCC antibodies proved positive, but not with N-t ype VGCC and synaptotagmin antibodies. A review of the literature turned up a few patients with voiding dysfunction related to LEMS, but no urodynamic studies were done on these patients. Ours is the first case in which 3,3-D AP was efficacious in treating LEMS and neurogenic bladder. Responses of 3, 4-DAP in urodynamic studies suggest that in this: LEMS patient neurogenic b ladder was caused by defective neurotransmission both in the autonomic detr usor and skeletal abdominal muscles. (C) 2001 Published by Elsevier Science B.V.