Clinical features

The presentation of Lambert Eaton syndrome:

• gradual onset of limb weakness - usually in the legs, less often in the arms (predominantly proximal pattern)
• patients usually describe fatigue on exercise - but characteristically, there is a post-tetanic increase in strength, lasting for a few seconds
• reflexes are usually absent or depressed but show post-tetanic potentiation
• ocular involvement - ptosis in 50% of cases; no other external ophthalmoplegia
• autonomic features - dry mouth, constipation, impotence