Positive ice pack test in a patient with Lambert‐Eaton myasthenic syndrome

Abstract

In contrast to myasthenia gravis, ptosis is usually a late manifestation in LEMS, but there are recent case reports of pure ocular LEMS. 8 Oculobulbar symptoms at presentation occur in only 5% of patients with LEMS, as compared to 90% of those with myasthenia gravis, but are found in approximately 30% by 3 mo and 50% by 12 mo. 9 There are reports of the ice pack test being positive in patients with ptosis secondary to the cosmetic use of botulinum toxin type A. 10 Here, an ice pack test resulted in improvement in ptosis in a patient with confirmed LEMS. This suggests that the ice pack test cannot be used to differentiate a presynaptic from a postsynaptic NM junction disorder.

What is in the Neuromuscular Junction Literature?

“…There were 2 recent interesting case reports on this topic. Awatare et al 30 reported a 72-year-old man with a one-year history of gradually progressive difficulty climbing stairs and standing up from a seated position. He had constipation, dry mouth, and erectile dysfunction.…”

“…This case report nicely illustrates that the ice pack test can be positive in LEMS. 30 Its overall sensitivity in LEMS is unknown, and ptosis may not be very prominent with LEMS. The ice pack test is reported to be sensitive in about 77% with MG with a specificity of 98%.…”