International Journal of Versatile Research and Analysis · Jul 2026
Physiotherapy Management of an Older Adult with LambertEaton Myasthenic Syndrome Presenting with Proximal Limb Weakness and Autonomic Dysfunction: A Case Report
By Patoliya DH, Panchal R
Introduction: Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune presynaptic disorder of the neuromuscular junction, with an estimated prevalence of approximately 2.6 to 10 cases per million population.1,2 It is frequently under-recognized in physiotherapy settings because its insidious, fatigable proximal weakness can mimic deconditioning, lumbar radiculopathy, or age-related sarcopenia in older adults. This report describes the physiotherapy assessment and rehabilitation of a 60-year-old retired male with autoimmune LEMS, with particular attention to the use of low-intensity, fatigue-monitored exercise progression — an approach with limited prior documentation in the physiotherapy literature, as no controlled trials of physiotherapy specifically in LEMS currently exist. Case presentation: A 60-year-old retired male presented with a six-month history of progressive bilateral proximal lower limb weakness, difficulty rising from a chair and climbing stairs, dry mouth, and mild ptosis that worsened through the day and partially recovered with brief exertion. Tendon reflexes were diminished but augmented following sustained contraction. Management and outcomes: Diagnosis was confirmed by repetitive nerve stimulation showing post-tetanic facilitation and positive P/Q-type voltage-gated calcium channel (VGCC) antibodies, with no malignancy detected on staging investigations. Medical management with pyridostigmine and graded immunotherapy was combined with a physiotherapy programme emphasising submaximal aerobic and resistance exercise, energy conservation education, balance retraining, and fatigue self-monitoring. Over 12 weeks, the patient demonstrated improved manual muscle testing grades, a clinically meaningful reduction in Timed Up and Go time, and improved scores on the Myasthenia Gravis Quality of Life scale, without provoking overwork weakness. Conclusion: Individually tailored, fatigue-monitored physiotherapy can be safely incorporated alongside immunomodulatory and symptomatic pharmacological treatment in LEMS, supporting functional independence in an older adult. Close collaboration between neurology and physiotherapy, with vigilance for overwork weakness and underlying malignancy, is essential.