Treatment

There is no cure for LEMS, although both paraneoplastic and non-paraneoplastic forms are treatable. The progression of LEMS is determined by whether or not it occurs with cancer. If cancer is present, that logically becomes the treatment priority. A patient may need to be under the care of both an oncologist and neurologist.

In general, treatment for autoimmune diseases attempts to reduce immune system activity.  LEMS may be treated through a variety of medications and protocols. The prescribed therapy will be unique for each patient and may include one or more drugs. Drugs are used to either increase the transmission of acetylcholine (Ach) or decrease the action of acetylcholinesterase. Therapy should aim to reduce the number of antibodies, which in effect limits their attack on the nerves and therefore improves muscle function.

Common treatments may include:

  • Steroids—suppress the immune system
  • Plasmapheresis—filters blood to remove antibodies
  • Intraveneous immunoglobulin--decreases anti-acetylcholine receptor antibodies (AchRAb)
  • Monoclonal Antibodies—stop antibodies from working
  • Cholinesterase inhibitors  increase the amount of acetylcholine received by the muscle and improve function
  • Aminopyridines increase the number of nerve impulses by causing more acetylcholine to be released
  • Di-amino pyridine or pyridostigmine bromide which enhance neuromuscular transmission

Patients may also benefit or find relief from non-specific LEMS treatments and complementary therapies such as:

  • Acupuncture
  • Anti-inflammatories
  • Chiropractic therapy
  • Herbal treatments
  • Hypnosis
  • Immunosuppressive medication
  • Pain medication
  • Physical therapy
  • Yoga
Current Drug Trials for LEMS Patients

Amifampridine phosphate Phase 3 (LMS003/ FirST-4-LEMS) (see clinicaltrials.gov:  NCT02970162)

Amifampridine phosphate (see clinicaltrials.gov:  NCT02189720)
Expanded Access Program  (EAP) Phase IV open label study. EAP can be used to treat patients with investigational drugs when no other treatment is available. Patients can only receive the drug with a prescription from a physician registered with the FDA under an EAP program.

3, 4-Diaminopyridine (see clinicaltrials.gov: NCT00872950) 
Thirty participants are currently being recruited for a study is to determine the effectiveness and adverse effects of 3, 4-diaminopyridine for the treatment of LEMS and Congenital Myasthenic Syndromes (CMS).