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MG and LEMS overlap syndrome: case report with electrophysiological and immunological evidence
1Department of Neurology, The University of Alabama at Birmingham, 35294, USA. shinjoh@uab.edu
Insights
This study details a unique case of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) overlap syndrome. The patient showed distinct clinical, electrophysiological, and immunological markers, confirming it as a separate neurological entity.
Area of Science:
- Neurology
- Immunology
Background:
- Myasthenia Gravis (MG) and Lambert-Eaton Myasthenic Syndrome (LEMS) are distinct neuromuscular junction disorders.
- Overlap syndromes present diagnostic challenges.
Observation:
- A patient with pernicious anemia presented with ptosis, diplopia, proximal leg weakness, and areflexia.
- Edrophonium test was positive, and repetitive nerve stimulation showed initial MG and later LEMS patterns.
- Immunological testing revealed positive acetylcholine receptor antibodies (ACh-ab) and N-type voltage-gated calcium-channel antibodies (VGCC-ab).
Findings:
- The patient exhibited a combination of clinical, electrophysiological, and immunological features of both MG and LEMS.
- This case provides strong evidence for an MG and LEMS overlap syndrome.
Implications:
- MG and LEMS overlap syndrome is a distinct clinical entity.
- Recognition of this overlap syndrome is crucial for accurate diagnosis and management.
- Further research into the pathogenesis of such overlap syndromes is warranted.
Objective:
To report the clinical, electrophysiological, and immunological findings in one patient with MG and LEMS overlap syndrome (myasthenia gravis and Lambert-Eaton myasthenic syndrome).
Methods:
Evaluation of clinical, electrophysiological, and immunological findings in one patient with this disease.
Results:
A female patient with pernicious anemia had clinical findings of ptosis, diplopia, proximal leg weakness, areflexia and a positive edrophonium test as well as the classic patterns initially of MG and later of LEMS on successive repetitive nerve stimulation (RNS) tests. Immunologically she demonstrated positive acetylcholine receptor antibody (ACh-ab) and positive N-type voltage-gated calcium-channel antibody (VGCC-ab) titers.
Conclusions:
Among five reported cases combining the features of MG and LEMS and having positive AChR- and VGCC-ab titers, our patient provides the most convincing clinical, electrophysiological, and immunological evidence for the existence of MG and LEMS overlap syndrome.
Significance:
MG and LEMS overlap syndrome is a distinct entity.
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