LAMBERT-EATON MYASTHENIA

SYNDROM
PADA ADENOCARCINOMA PARU
STADIUM IV
Dwi Asep Rianto Fani*, Hasnawi Haddani**
*) Residen, Departemen Neurologi, Fakultas Kedokteran Universitas
Sriwijaya / RS. Moh Hoesin, Palembang
**) Staf Pengajar, Departemen Neurologi, Fakultas Kedokteran Universitas
Sriwijaya / RS. Moh.Hoesin, Palembang
ABSTRAK
Latar belakang : Lambert-Eaton Myasthenia Syndrom (LEMS) adalah
gangguan transmisi neuromuskuler presynaptic langka yang ditandai
kelemahan otot proksimal, refleks tendon menurun, dan perubahan
otonom. LEMS adalah suatu gangguan akibat reaksi autoimun dimana
antibodi dibentuk terhadap voltage-gated calcium channels di presinaptik,
dan kemungkinan protein terminal syaraf lainnya dalam sambungan
neuromuskuler. Mayoritas kanker yang berhubungan dengan LEMS adalah
small cell lung cancer (SCLC). Namun, banyak keganasan yang berbeda
juga terlibat, salah satunya termasuk non small cell lung cancer (NSCLC).
Laporan kasus : Seorang pria berusia 30 tahun dirawat di bagian
Penyakit Dalam RSMH karena mengalami batuk darah dan sesak nafas.
Penderita lalu dikonsulkan ke bagian Neurologi RSMH dikarenakan
kelemahan pada ke-empat ekstremitas yang terjadi secara perlahan-lahan
sejak lebih kurang sejak 2 bulan sebelumnya. Kelemahan dialami
penderita pada saat pagi hari pada ke-empat ekstremitas terutama pada
lengan dan otot paha. Penderita juga sering mengalami kelemahan saat
sedang beristirahat, saat hendak berjalan dan saat hendak naik tangga.
Namun kelemahan membaik dengan aktifitas fisik. Pada pemeriksaan
ENMG didapatkan suatu axonal demyelinating motorik polineuropati, dan
pada pemeriksaan RNS pada stimulus didapatkan increment > 10%.
Penderita juga sebelumnya dari bagian penyakit dalam telah didiagnosa
dengan adenokarsinoma paru stadium IV.
Kesimpulan : Lambert-Eaton Myasthenia Syndrom (LEMS) adalah
gangguan autoimun langka yang ditandai dengan kelemahan otot
extremitas. Terapi pada penderita sangat bergantung kepada keberhasilan
terapi kanker primer. Hal ini disebabkan karna LEMS ini merupakan suatu
paraneoplastic syndrom.

Kata kunci Lambert-Eaton Myasthenia Syndrom, LEMS, small cell lung

cancer (SCLC), non small cell lung cancer (NSCLC), autoimun,
paraneoplastic syndrom.

LAMBERT-EATON MYASTHENIA
SYNDROM
IN STAGE IV LUNG
ADENOCARCINOMA
Dwi Asep Rianto Fani*, Hasnawi Haddani**
*) Resident, Department of Neurology, Faculty of Medicine Universitas
Sriwijaya / Moh. Hoesin Hospital, Palembang.
**) Staff, Department of Neurology, Faculty of Medicine Universitas
Sriwijaya / Moh. Hoesin Hospital, Palembang.

ABSTRACT
Background :
Lambert-Eaton Myasthenia Syndrom (LEMS) is a rare
disorder of neuromuscular transmission characterized presynaptic
proximal muscle weakness, decreased tendon reflexes and autonomic
changes. LEMS is a disorder due to an autoimmune reaction where the
antibodies formed against voltage-gated calcium channels in the
presynaptic, and possibly other nerve terminal protein in the
neuromuscular junction. The majority of cancers associated with LEMS is
small cell lung cancer (SCLC). However, many different malignancies were
also involved, one of which included non-small cell lung cancer (NSCLC).
Case report : A 30-year-old man was treated at the Internal Medicine
RSMH as experienced coughing up blood and shortness of breath. Patients
then consulted the RSMH Neurology part due to the weakness in all four
extremities occurring slowly since more or less since 2 months earlier.
Weakness experienced by patients at the time of the morning on all four
extremities, especially the arms and thigh muscles. Patients also often
experience weakness while taking a break, when they want and when
they want to walk up the stairs. But the weakness improved with physical
activity. On examination ENMG obtained a motor axonal demyelinating

polyneuropathy, and the examination of the stimulus RNS obtained

increment of> 10%. Patients are also previously of parts have been
diagnosed with the disease in stage IV lung adenocarcinoma.
Conclusion : Lambert-Eaton Myasthenia Syndrom (LEMS) is a rare
autoimmune disorder characterized by muscle weakness of extremities.
Therapy in this patients highly dependent on the success of primary
cancer therapy. This is because LEMS is a paraneoplastic syndrome.
Keywords: Lambert-Eaton Myasthenia Syndrom, LEMS, small cell lung
cancer (SCLC), non small cell lung cancer (NSCLC), autoimun,
paraneoplastic syndrom.