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Profile of aminopyridines for Lambert–Eaton myasthenic syndrome

Authors Maddison P, Keogh M, Sedehizadeh S

Received 26 September 2013

Accepted for publication 6 November 2013

Published 20 January 2014 Volume 2014:4 Pages 11—18


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Paul Maddison,1 Michael J Keogh,2 Saam Sedehizadeh1

1Department of Clinical Neurology, Queen's Medical Centre, Nottingham, UK; 2Institute of Human Genetics, University of Newcastle upon Tyne, International Centre for Life, Newcastle upon Tyne, UK

Abstract: 3,4-diaminopyridine (3,4-DAP) is an effective, symptomatic treatment for Lambert–Eaton myasthenic syndrome (LEMS). Several trials have studied the effects of 3,4-DAP in small numbers of LEMS patients. We systematically reviewed all randomized trials of 3,4-DAP in LEMS to determine the efficacy of this treatment using meta-analysis of clinical and electrophysiological end points. Data from four randomized, placebo-controlled trials revealed that muscle-strength scores increased significantly with 3,4-DAP. Limited meta-analysis performed on two trials using the quantitative myasthenia gravis score indicated that the clinical benefits seen were modest, with an improvement in quantitative myasthenia gravis score of 2.44 points (95% confidence interval: 1.2–3.6). Meta-analysis of the mean change in compound muscle action potential amplitude following 3,4-DAP treatment revealed a significant improvement compared to placebo (1.36 mV, 95% confidence interval: 0.99–1.72). 3,4-DAP is an effective, safe, first-line symptomatic treatment for LEMS, with significant clinical and electrophysiological benefits demonstrated by meta-analysis.

Keywords: Lambert–Eaton myasthenic syndrome, 3,4-diaminopyridine, meta-analysis

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