The management of Lambert Eaton syndrome in the setting of hypertensive disorders of pregnancy: A literature review

Objective

To review the literature regarding the management of Lambert Eaton Myasthenic Syndrome (LEMS) in pregnancy, with a focus on the clinical challenges posed by coexisting hypertensive disorders, including preeclampsia and the routine use of magnesium sulfate for seizure prophylaxis.

Data sources

A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted through May 2024 using combinations of keywords and MeSH terms including “Lambert Eaton Myasthenic Syndrome,” “LEMS,” “pregnancy,” “preeclampsia,” “magnesium sulfate,” and “hypertensive disorders of pregnancy.”

Study eligibility criteria

Studies were included if they reported pregnancy outcomes, maternal complications, or management considerations in patients with LEMS or related myasthenic syndromes. Exclusion criteria included non-English language publications, animal studies, and review articles without case-level data.

Study appraisal and synthesis methods

Studies were appraised based on relevance to Lambert-Eaton Myasthenic Syndrome in pregnancy, with particular attention to hypertensive complications and seizure prophylaxis strategies. Due to the rarity of this condition, included articles were primarily case reports and case series. Data were synthesized using a qualitative narrative approach, focusing on clinical presentation, interventions, and maternal-neonatal outcomes. Studies involving myasthenia gravis were also reviewed for comparison, given overlapping neuromuscular risks. No formal risk-of-bias assessment or statistical pooling was conducted due to heterogeneity and limited sample size.

Results

Twenty-four citations were included, encompassing case reports, case series, and retrospective analyses. Of these, 5 (21%) specifically involved LEMS during pregnancy, and 2 (8%) reported transient neonatal LEMS. Magnesium sulfate was discussed in 3 (13%) studies, with at least one case documenting exacerbation of neuromuscular symptoms. Two cases involved the co-occurrence of preeclampsia and LEMS, highlighting the dilemma of balancing seizure prophylaxis with neuromuscular safety. No standardized treatment protocols were identified. Multidisciplinary care and individualized decision-making were emphasized across reports.

Conclusions

The intersection of LEMS and hypertensive disorders of pregnancy is clinically complex and underreported. The use of magnesium sulfate—a cornerstone of preeclampsia management—poses a potential risk for patients with LEMS, underscoring the need for heightened awareness, individualized treatment plans, and multidisciplinary collaboration. Further research is needed to establish safe, evidence-based guidelines for managing this rare but high-risk patient population.