Overlap myasthenic syndrome

This is a report of a case of overlap myasthenic syndrome i.e. one which has the feature of both myasthenia gravis and lambert Eaton myasthenic syndrome (LEMS). The patient had first thyrotoxicosis and then was seen with bulbar and limb weakness andEMG showed decrement on repetitive tests at 3Hz. A second admission was for what appeared to be an axonal degeneration neuropathy with respiratory embarrassment. This was based on nerve conduction studies showing low muscle action potentials in all muscles with normal conduction velocities. There was a good response to steroids and relapse on stopping steroids and on the third admission all the electrophysiologic features of LEMS were noted. At his time the patient had bulbar and facial weakness and an excellent response to Prostigmine suggesting associated myasthenia gravis. This is the first overlap myasthenic syndrome reported from India.