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Voltage-Gated Calcium Channel Antibody (VGCCA) TestThis test measures the P/Q-type voltage-gated calcium channel (VGCC) antibodies as an aid in the diagnosis of Lambert-Eaton myasthenic syndrome (LEMS) as well as differentiating LEMS from myasthenia gravis. LEMS is an autoimmune disorder of neuromuscular transmission that affects the presynaptic release of acetylcholine. The release of acetylcholine from storage vesicles in the nerve ending is regulated by the influx of calcium through voltage-gated channels. The impairment of acetylcholine release results in fatiguability and muscle weakness that is characteristic of the disease. LEMS is a paraneoplastic syndrome that is highly associated with small-cell lung carcinoma. This association is thought to be due to antigenic similarity between proteins found in the tumor cells and the voltage-gated calcium channel proteins. Classic symptoms of LEMS include proximal muscle weakness, fatiguability, dry mouth and impotence. When presentation is further complicated with oculobulbar weakness, these symptoms can be easily misinterpreted as myasthenia gravis. However, because VGCC antibodies are positive in only approximately 5% of MG patients, in comparison to approximately 95% of LEMS patients, the measurement of these antibodies is very useful in distinguishing LEMS from myasthenia gravis.
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