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Is Weak Painful Muscles Be A Symptom Of LEMS?

Posted on Thu, 26 Jun 2014

Question: I am a 29yo male and I have P/Q VGCC Antibodies in my blood. Its been checked twice. In October of 2013 the P/Q antibodies was at 0.18 and as of March of 2014, it was at 0.20. I also had a negative PET Scan and negative EMG. My neurologist dismisses LEMS due to clear PET Scan and EMG. I've expressed to him on numerous times that my muscles do go weak and I have pain in the muscles of my legs and back. I do suffer from Meniscus in both knees and also a Cam and Pincer issues in my right hip joint. I walk with a cane inside of my home but need a wheelchair outside I.e. grocery shopping and such. I also suffer from PTSD which has been mentioned as the reason for pain and weakness which I dispute on the basis of I can differentiate the anxiety attack feeling and physical pain. So my question is, would you diagnose it as LEMS or dismiss it based upon clear EMG and PET Scan?

Answered by Dr. Sudhir Kumar (6 hours later)

Brief Answer:
Can not diagnose a definite LEMS at this stage.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your symptoms and reports of investigations.

It is not possible to give a definite label of LEMS in your case at this stage. However, the suspicion still remains and you should be closely monitored.

It is common for a diagnosis of LEMS to be missed or delayed.

SCLC may be missed and may appear upto three years after the appearance of VGCC auto-antibodies.

As of now, I would recommend close follow up, and periodic PET scans to detect SCLC.

I hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.

Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (46 minutes later)

Thanks for responding. My other question would be, should I seek a second opinion? My current Neurologist is wanting to pass it off as a false positive. I've had the blood tested twice and with the PET scan being clear and the EMG, he thinks there's no reason for concern or alarm and has gone to great length to tell me so.

Answered by Dr. Sudhir Kumar (7 minutes later)

Brief Answer:
May be after another three months.

Detailed Answer:
Thank you for getting back.

In any case, you need to go for review every six months, even if you are stable. So, in the next neurology review (after three months from now), you may opt to consult another neurologist.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar