Weakness of the bulbar muscles (muscles of the mouth and throat) is occasionally encountered. Weakness of the eye muscles is uncommon. Some may have double vision, drooping of the eyelids and difficulty swallowing, but generally only together with leg weakness; this too distinguishes LEMS from myasthenia gravis, in which eye signs are much more common. In the advanced stages of the disease, weakness of the respiratory muscles may occur. Some may also experience problems with coordination (ataxia).Three-quarters of people with LEMS also have disruption of the autonomic nervous system. This may be experienced as a dry mouth, constipation, blurred vision, impaired sweating, and orthostatic hypotension (falls in blood pressure on standing, potentially leading to blackouts). Some report a metallic taste in the mouth.On neurological examination, the weakness demonstrated with normal testing of power is often less severe than would be expected on the basis of the symptoms. Strength improves further with repeated testing, e.g. improvement of power on repeated hand grip (a phenomenon known as "Lamberts sign"). At rest, reflexes are typically reduced; with muscle use, reflex strength increases. This is a characteristic feature of LEMS. The pupillary light reflex may be sluggish.In LEMS associated with lung cancer, most have no suggestive symptoms of cancer at the time, such as cough, coughing blood, and unintentional weight loss. LEMS associated with lung cancer may be more severe. Causes
LEMS is often associated with lung cancer (50–70%), specifically small-cell carcinoma, making LEMS a paraneoplastic syndrome. Of the people with small-cell lung cancer, 1–3% have LEMS.
This initial dissociation of the most terrifying events they experienced with their captors prevented the four victims from facing the disintegration of their ego structures. Once freed, the most frightening and toxic actual events they experienced are assumed to be still held out of awareness, as revisiting those events are likely to bring up overwhelming emotions. Fairbairn noted that one of the primary reasons for keeping horrifying memories in the unconscious was because of the emotional disruption caused when they are re-experienced.There is little doubt in my mind, in conjunction with another factor to be mentioned later, that the deepest source of resistance is fear of the release of bad objects from the unconscious: for when such bad objects are released, "the world around the patient becomes peopled with devils which are too terrifying to face" (Fairbairn, 1952, p.69-70). This quote graphically describes the results of suddenly remembering those memories of interpersonal events between the captives and captors that were saturated with fear, dread and hopelessness. There is no reason now, given the fact that the captivity is long over, for the four victims to remember the horrifying details. Libidinal ego-exciting object side of the split
The other side of the split is abundantly obvious. All four victims refused to testify against their captors, and in fact raised money for their defense. Thus, given Fairbairns theory, they continue to see their captors through their libidinal egos as if the captors have a hidden storehouse of goodness somewhere in them.