title: [Mixed pre- and postsynaptic neuromuscular block].
abstract: We report a new case of neuromuscular block overlap between Myasthenia Gravis and Eaton-Lambert syndrome. A 64-year-old man with a 4-months history of gait disturbance was admitted for ophthalmoplegia worsening during exercise and decreasing at rest. Clinical examination after exercise, revealed limbs weakness and areflexia, palsy of the left eye abduction and a left ptosis. The level of anti-acetylcholin-receptor antibodies was high. Electrophysiological explorations revealed a decrement at 3 Hz and a increment at 30 Hz, with a reduction in amplitude of the initial motor potential. This patient improved under a combination of guanidine and anticholinesterase drugs. From this case and 9 previously reported cases, we propose 4 criteria for the diagnosis of such neuromuscular blocks: 1) exercising symptoms and signs, including areflexia, 2) presence of anti-acetylcholin-receptor antibodies, 3) reduction of the amplitude of the initial motor potential, with a decrement at 3 Hz, and an increment at 30 Hz, and 4) clinical and electrophysiological improvement under guanidine and anticholinesterasic drugs therapy.
authors.affiliation: Service de Neurologie B, Centre hospitalo-universitaire de Lille.
authors.forename: P
authors.initials: P
authors.lastname: Rondepierre
authors.forename: A
authors.initials: A
authors.lastname: Furby
authors.forename: O
authors.initials: O
authors.lastname: Godefroy
authors.forename: J F
authors.initials: JF
authors.lastname: Hurtevent
authors.forename: A
authors.initials: A
authors.lastname: Destée
authors.forename: F
authors.initials: F
authors.lastname: Fourrier
authors.forename: D
authors.initials: D
authors.lastname: Leys
mesh_terms: D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004576:Electromyography; D004594:Electrophysiology; D006146:Guanidines / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013570:Synaptic Membranes
chemical_list: D002800:Cholinesterase Inhibitors; D006146:Guanidines
vernacular_title: Bloc neuromusculaire mixte pré- et post-synaptique.