Monitoring

Patients should be followed up by a neuromuscular specialist. Frequency of clinic visits is determined by severity of weakness, presence of medical comorbidities, and monitoring of drug therapy. The Dutch-English Lambert-Eaton Tumor Association Prediction score is of value in discriminating patients with Lambert-Eaton myasthenic syndrome (LEMS) with and without small cell lung cancer early in the course of LEMS; however, cancer screening should be pursued in all patients with LEMS.[55][56]​​ After initial cancer screening, routine monitoring should be performed based on risk factors. Chest CT is recommended every 6 months for at least 2 years following diagnosis.[8][35]​ Intravascular contrast agents containing ionic or chelating agents should be avoided because use has resulted in exacerbation of weakness.[43] Cancer is typically discovered within 2 years of presentation, although the diagnosis may be delayed for up to 10 years.

Monitoring for corticosteroid treatment adverse effects

  • Bone density is measured at baseline and regularly during corticosteroid treatment. Osteoporosis prophylaxis may be indicated for patients receiving high-dose corticosteroid treatment. See Osteoporosis (Prevention).

  • Initial fasting blood glucose and regular blood glucose levels are recommended in chronic corticosteroid treatment.

  • H2 antagonists or proton pump inhibitors may be prescribed if the patient develops gastrointestinal discomfort or has a history of peptic ulcer disease.

  • Eye exams are performed periodically to check for cataracts and glaucoma.

  • Serum potassium levels are monitored. Potassium supplementation may be required if the patient becomes hypokalemic.

Monitoring for azathioprine adverse effects

  • Measurement of baseline and periodic PFTs with diffusion is recommended.

  • CBC and LFTs including gamma-GT are checked every 1-2 weeks until on a stable dose, then once a month.

Monitoring for intravenous immune globulin (IVIG) adverse effects

  • Measurement of baseline renal function is recommended because of risk of IVIG-induced renal failure.

Monitoring for disease severity and response to therapy

The Triple Timed Up-and-Go test is a validated and objective measure of mobility for patients with LEMS. It is a simple test that can be performed in the doctor's office and has been used as a primary endpoint in clinical trials. It requires the patient to stand up from the seat of a straight-backed, standard-height, armless, hard chair. The patient then walks 3 meters (10 feet) at a normal pace, turns around, walks back to the chair and sits back down. This is repeated for a total of three laps. The individual lap times are averaged, but fatigability or improvement can be analyzed by assessing the individual lap times.[57][58]

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