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@ARTICLE{Preler:282604,
author = {Preßler, Hannah and Haddy, Imène and Daugherty, Claire
and Postila, Ville and Meisel, Andreas},
title = {{P}araneoplastic {L}ambert-{E}aton myasthenic syndrome
associated with non-small cell lung cancer: data from the
{E}uropean {LEMS} registry and systematic review.},
journal = {Neurological research and practice},
volume = {7},
number = {1},
issn = {2524-3489},
address = {[London]},
publisher = {BioMed Central},
reportid = {DZNE-2025-01362},
pages = {95},
year = {2025},
abstract = {Paraneoplastic Lambert-Eaton myasthenic syndrome (pLEMS) is
well-established in small-cell lung cancer (SCLC), but data
on other malignancies are limited. We aimed to define the
clinical phenotype of pLEMS in non-SCLC cancers
(non-SCLC-pLEMS) relative to SCLC-associated LEMS
(SCLC-pLEMS) and autoimmune LEMS (aiLEMS).Retrospective
analysis was conducted to compare patients with SCLC-pLEMS,
aiLEMS and non-SCLC-pLEMS from the European LEMS registry,
and further non-SCLC-pLEMS cases were identified by a
systematic review following the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines.The registry included 72 aiLEMS, 12 SCLC-pLEMS,
and 11 non-SCLC-pLEMS patients. LEMS preceded cancer
diagnosis in $33\%$ of SCLC-pLEMS (median 2 months) and
$30\%$ of non-SCLC-pLEMS (median 15 months), was concurrent
in $25\%$ and $30\%$ and followed tumor diagnosis in the
remainder. At study enrollement, Quantitative Myasthenia
Gravis (QMG) scores were higher in SCLC-pLEMS (median 12,
range 1-24) with recent tumor therapy initiation (median 3
months), and lower in non-SCLC-pLEMS (median 6, range 0-19),
with longer (median 12 months) or completed tumor therapy,
and aiLEMS (median 5, range 0-23). During follow-up, QMG
improved with tumor therapy, and worsened with
recurrence/progression in pLEMS groups. After completion of
cancer treatment, QMG values in SCLC-pLEMS (median 6, range
0-19) and non-SCLC-pLEMS (median 5, range 1-22) were
comparable to each other and to aiLEMS (median 7, range
0-29). Ataxia was significantly more frequent in SCLC-pLEMS
$(64\%)$ and non-SCLC-pLEMS $(55\%)$ than in aiLEMS $(19\%,$
p = 0.006 and p = 0.024). Another 115 literature-reported
non-SCLC-pLEMS cases were identified (total n = 126,
comprising 137 tumors). Most common were non-small cell lung
cancer (NSCLC) (n = 25, $18\%),$ Merkel cell carcinoma (n =
18, $13\%)$ and lymphoproliferative disorders (n = 15,
$11\%).$ In 52 literature-reported LEMS patients with
outcome data, $88\%$ partially or fully recovered after
tumor therapy, leaving the paraneoplastic origin uncertain
in many.Our results suggest that, beyond SCLC, other tumors
can trigger pLEMS. Compared with aiLEMS, non-SCLC-pLEMS and
SCLC-pLEMS showed a higher frequency of ataxia, and LEMS
severity tended to reflect tumor treatment status, while
disease severity becomes comparable across subtypes after
cancer therapy. The frequent improvement of symptoms with
tumor-directed treatment supports extended screening beyond
SCLC and timely management.},
keywords = {Ataxia (Other) / Cancer treatment (Other) / Lambert-Eaton
myasthenic syndrome (Other) / Paraneoplastic (Other) / Tumor
(Other)},
cin = {AG Prüß},
ddc = {610},
cid = {I:(DE-2719)1810003},
pnm = {353 - Clinical and Health Care Research (POF4-353)},
pid = {G:(DE-HGF)POF4-353},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:41361909},
pmc = {pmc:PMC12687528},
doi = {10.1186/s42466-025-00453-5},
url = {https://pub.dzne.de/record/282604},
}