An i m p r o v e d d i a g no s t i c a s s a y f o r L a m b e r t - E a t o n m y a s t h e ni c s y nd r o m e

5 S h e r E , G o t t i C , C a na l N , S c o p p e t t a C , P i c c o l o G , E v o l i A,
C l e m e nt i F . S p e c i f i c i t y o f c a l c i u m c h a nne l a u t o a nt i b o d i e s
i n L a m b e r t - E a t o n m y a s t h e ni c s y nd r o m e . L a nc e t 1 9 8 9 ; i i :
6 4 0 - 3 .
6 L e nno n V A, L a m b e r t E H. Au t o a nt i b o d i e s b i nd s o l u b i l i z e d
c a l c i u m c h a nne l w - c o no t o x i n c o m p l e x e s f r o m s m a l l c e l l
l u ng c a r c i no m a : A d i a g no s t i c a i d f o r L a m b e r t - E a t o n
m y a s t h e ni c s y nd r o m e . Ma y o C l i n P r o c 1 9 8 9 ; 6 4 :
1 4 9 8 - 5 0 4 .
7 O g u r o - O k a no M, G r i e s m a nn G E , W i e b e n E D , S l a y m a k e r
S J , S nu t c h T P , L e nno n V A. Mo l e c u l a r d i v e r s i t y o f
ne u r o na l - t y p e c a l c i u m c h a nne l s i d e nt i f i e d i n s m a l l c e l l
l u ng c a r c i no m a . Ma y o C l i n P r o c 1 9 9 2 ; 6 7 : 1 1 5 0 - 9 .
8 U c h i t e l O D , P r o t t i D A, S a nc h e z V , C h e r s k e y BD ,
S u g u m o r i M, L l i na s R P - t y p e v o t a g e - d e p e nd e nt c a l -
c i u m c h a nne l m e d i a t e s p r e s y na p t i c c a l c i u m i nf l u x a nd
t r a ns m i t t e r r e l e a s e i n m a m m a l i a n s y na p s e s . P r o c N a d
Ac a d S c i U S A 1 9 9 2 ; 8 9 : 3 3 3 0 - 3 .
9 J o h ns t o n I , L a ng B, L e y s K , N e w s o m - D a v i s J .
He t e r o g e ne i t y o f c a l c i u m c h a nne l a u t o a nt i b o d i e s
d e t e c t e d u s i ng a s m a l l - c e l l l u ng c a nc e r l i ne d e r i v e d f r o m
a L a m b e r t - E a t o n m y a s t h e ni c s y nd r o m e p a t i e nt .
N e u r o l o g y 1 9 9 4 ; 4 4 : 3 3 4 - 8 .
1 0 L a ng B, J o h ns t o n I , L e y s K , e t a l . Au t o a nt i b o d y s p e c i f i c i t i e s
i n L a m b e r t - E a t o n m y a s t h e ni c s y nd r o m e . Ann N YAc a d
S c i 1 9 9 3 ; 6 8 1 : 3 8 2 - 9 3 .
1 1 Hi l l y a r d D R, Mo nj e V D , Mi nt z I M, e t a l . A ne w p e p t i d e
l i g a nd f o r m a m m a l i a n p r e s y na p t i c C a
2
c h a nne l s .
N e u r o n 1 9 9 2 ; 9 : 6 9 - 7 7 .
1 2 L e nno n V A, K r v z e r T , G r i e s m a nn G E , e t a l . P - L i k e C a 2 +
c h a nne l s i n h u m a n c e r e b e l l u m a nd s m a l l c e l l l u ng
c a r c i no m a b i nd a - c o no t o x i n- MV I I C a nd a r e i m m u no -
p r e c i p i t a b l e b y L a m b e r t - E a t o n m y a s t h e ni c s y nd r o m e
I g G t h a t r e a c t h i g h l y w i t h N - t y p e C a 2 + c h a nne l s . S o c i e t y
f o r N e u r o s c i e nc e s ( a b s t r a c t ) 1 9 9 3 ; 1 9 : 1 7 5 3 .
1 3 V i nc e nt A, N e w s o m - D a v i s J . Ac e t y l c h o l i ne r e c e p t o r a nt i -
b o d y a s a d i a g no s t i c t e s t f o r m y a s t h e ni a g r a v i s : r e s u l t s i n
1 5 3 v a l i d a t e d c a s e s a nd 2 9 6 7 d i a g no s t i c a s s a y s . J N e u r o l
N e u r o s u r g P s y c h i a t r y 1 9 8 5 ; 4 8 : 1 2 4 6 - 5 2 .
1 4 N e w s o m - D a v i s J , Mu r r a y N MF . P l a s m a e x c h a ng e a nd
i m m u no s u p p r e s s i v e d r u g t r e a t m e nt i n t h e L a m b e r t -
E a t o n m y a s t h e ni c s y nd r o m e . N e u r o l o g y 1 9 8 4 ; 3 4 : 4 8 0 - 5 .
1 5 D e L u c a A, L i C G , Ra nd MJ , Re i d I J , T h a i na P , W o ng -
D u s t i ng HK . E f f e c t s o f e o - c o no t o x i n G V I A o n a u t o -
no m i c ne u r o e f f e c t o r t r a ns m i s s i o n i n v a r i o u s t i s s u e s . Br J
P h a r m a c o l 1 9 9 0 ; 1 0 1 : 4 3 7 - 4 7 .
Hu g h l i ng s J a c k s o n a nd t h e Ho l ne s - Ad i e t o ni c
p u p i l
T h e na m e s o f G o r d o n Ho l m e s ' a nd W J a m e s Ad i e 2 3
a r e t r a d i t i o na l l y a t t a c h e d t o t h e s y nd r o m e o f m y o t o ni c
p u p i l s a nd t e nd o n a r e f l e x i a . S o m e 5 0 y e a r s e a r l i e r i n
1 8 8 1 , m y d r i a s i s w i t h p u p i l l a r y p a r a l y s i s w a s d e s c r i b e d
c l e a r l y b y Hu g h l i ng s J a c k s o n. 4 I n 1 9 1 4 O l o f f f o u nd
ne g a t i v e W a s s e r m a n r e a c t i o ns i n b l o o d a nd C S F i n a n
1 8 y e a r o l d b o y w i t h t o ni c p u p i l s , t h e r e b y s h o w i ng t h a t
s y p h i l i s - p r e v i o u s l y i m p l i c a t e d - w a s no t t h e c a u s e .
Ha r r i m a n a nd G a r l a nd ' c r e d i t e d e a r l i e r p a p e r s d a t i ng
t o 1 9 0 2 ( S t r a s s b u r g e r , S a e ne r ) t h a t d e s c r i b e d t o ni c
p u p i l s .
Hu g h l i ng s J a c k s o n4 :
"A w o m a n a g e d 2 6 w a s s e nt t o s e e m e s i m p l y
b e c a u s e t h e r i g h t p u p i l w a s m u c h l a r g e r t h a n t h e
l e f t . I t h a d b e e n s o t h r e e y e a r s . . . t h e r i g h t p u p i l
w a s d i l a t e d a nd a b s o l u t e l y m o t i o nl e s s t o l i g h t , a nd
a l s o d u r i ng a c c o m m o d a t i o n, y e t t h e a c c o m m o d a -
t i o n i t s e l f o n t h i s s i d e w a s p e r f e c t ; t h i s w a s s e v e r e l y
t e s t e d b y Mr C o u p e r . . . t h i s c a s e a t f i r s t p u z z l e d
m e . . . I t o c c u r r e d t o m e t o t e s t t h e k ne e s . N e i t h e r I
no r Mr C o u p e r f o u nd t h e s m a l l e s t t r a c e o f t h e k ne e
p h e no m e no n. S e v e r a l t i m e s d i d I p e r t i na c i o u s l y
i nq u i r e f o r o t h e r s y m p t o m s o f t a b e s ; t h e r e w e r e no
o t h e r s y m p t o m s o f a ny k i nd . . . D r Bu z z a r d
c o nf i r m e d t h e a b o v e o b s e r v a t i o ns . "
S i r G o r d o n Ho l m e s l :
"F r e q u e nt l y no c h a ng e i n t h e s i z e o f t h e p u p i l w a s
v i s i b l e i m m e d i a t e l y o n c o nv e r g e nc e , b u t w h e n t h i s
w a s m a i nt a i ne d f o r a f e w s e c o nd s t h e p u p i l s l o w l y
a nd g r a d u a l l y g r e w s m a l l e r , t i l l i t s d i a m e t e r e q u a l l e d
o r w a s e v e n na r r o w e r t h a n t h a t o f t h e no r m a l e y e .
T h e r a t e o f c o nt r a c t i o n v a r i e d v e r y m u c h . . . W h e n
c o nt r a c t e d t h e p u p i l r e m a i ns c o ns t a nt a nd w h e n
c o nv e r g e nc e i s r e l a x e d i t d i l a t e s s l o w l y . "
Ad i e 3 d e s c r i b e d 1 9 p a t i e nt s , 1 3 w i t h a b s e nt t e nd o n
r e f l e x e s , a nd no t e d 4 4 r e p o r t e d c a s e s o f t o ni c p u p i l . I n
a n e x e m p l a r y c l i ni c a l e s s a y , h e o u t l i ne d f o u r i nc o m -
p l e t e f o r m s ( t h e l a s t w o u l d no t no w b e a c c e p t e d ) .
"1 . T h e c o m p l e t e f o r m - t y p i c a l t o ni c p u p i l a nd
a b s e nc e o f r e f l e x e s .
2 . I nc o m p l e t e f o r m s : a ) t o ni c p u p i l a l o ne ; b ) a t y p i c a l
p h a s e o f t h e t o ni c p u p i l a l o ne ( i r i d o p l e g i a "; i nt e m a l
o p t h a l m o p l e g i a ") ; c ) a t y p i c a l p h a s e s o f t h e t o ni c
p u p i l w i t h a b s e nt r e f l e x e s ; d ) a b s e nt r e f l e x e s a l o ne . "
Ad i e d i d no t c l a i m o r i g i na l i t y , r e c o g ni s i ng d e s c r i p t i o ns
f r o m 1 9 0 2 . Ho l m e s 's w o r k i s no t a c k no w l e d g e d i n
Ad i e 's Br a i n p a p e r . Ad i e c o m m e nt e d o n t h e p a s t m i s -
c o ns t r u e d a t t r i b u t i o n t o s y p h i l i s : "A p e r v e r s i o n o f
ne r v o u s a c t i v i t y " o f t h e v e g e t a t i v e ne r v o u s s y s t e m w a s ,
h e t h o u g h t , t h e c a u s e .
I t w a s t h e L o nd o n o p h t h a l m o l o g i s t , J a m e s W a r e
( 1 7 5 6 - 1 8 1 5 ) , h o w e v e r , w h o f u r ni s h e d o ne o f t h e
e a r l i e s t d e p i c t i o ns i n 1 8 1 3 . 6
J M S P E ARC E
1 Ho m e s G . P a r t i a l i r i d o p l e g i a a s s o c i a t e d w i t h s y m p t o m s o f
o t h e r d i s e a s e s o f t h e ne r v o u s s y s t e m . T r a ns a c t i o ns o f t h e
O p h t h a l m o l o g i c a l S o c i e t y o f t h e U K 1 9 3 1 ; 5 1 : 2 0 9 - 2 8 .
2 Ad i e W J . C o m p l e t e a nd i nc o m p l e t e f o r m s o f t h e b e ni g n
d i s o r d e r c h a r a c t e r i s e d b y t o ni c p u p i l s a nd a b s e nt t e nd o n
r e f l e x e s . Br j ? O p h t h a l m o l 1 9 3 2 ; 1 6 : 4 4 9 - 6 1 .
3 Ad i e W J . T o ni c p u p i l s a nd a b s e nt t e nd o n r e f l e x e s : a
b e ni g n d i s o r d e r s u i g e ne r i s ; i t s c o m p l e t e a nd i nc o m p l e t e
f o r m s . Br a i n 1 9 3 2 ; 5 5 : 9 8 - 1 1 3 .
4 J a c k s o n J H. P a r a l y t i c a f f e c t i o ns . 1 . O n e y e s y m p t o m s i n
l o c o m o t o r a t a x y . T r a ns a c t i o ns o f t h e O p h t h a l m o l o g i c a l
S o c i e t y o f t h e U K 1 8 8 1 ; 1 : 1 3 9 - 5 4 .
5 Ha r r i m a n D G F , G a r l a nd H. T h e p a t h o l o g y o f Ad i e 's s y n-
d r o m e . Br a i n 1 9 6 8 ; 9 1 : 4 0 1 - 1 8 .
6 W a r e J . P h i l o s T r a ns R S o c L o nd 1 8 1 3 ; 3 1 - 5 0 [ s e e D u nn's
b i o g r a p h y o f W a r e . Br J O p h t h a l m o l 1 9 1 7 ; 1 : 4 0 1 - 1 0 ]
c i t e d b y L e a k e C D . I n: Ha y m a k e r W , S c h i l l e r F , e d s .
F o u nd e r s o f N e u r o l o g y . 2 nd e d . S p r i ng f i e l d , I l l i no i s :
T h o m a s , 1 9 7 0 ; 5 0 5 - 6 .
8 7
group.bmj.com on May 21, 2014 - Published by jnnp.bmj.com Downloaded from
doi: 10.1136/jnnp.58.1.87
1995 58: 87 J Neurol Neurosurg Psychiatry

J M S Pearce

tonic pupil
Hughlings Jackson and the Holmes Adie
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