The distinction between myasthenia gravis and Lambert Eaton myasthenic syndrome can usually be made by the clinical and neurophysiological features. A patient was observed with features which suggested a combination of both disorders. This has been described in few patients before. The importance of electromyography in both distal and proximal limb muscles for a correct diagnosis is demonstrated. Only in proximal nerve stimulation tests was proof found of the existence of both syndromes.
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