Diagnosis of LEMS is based on clinical symptoms and signs.

A few diagnostic testing

methods are available to help diagnose LEMS. Electrophysiological studies, are done to
measure muscle response and muscle strength. Repetitive nerve stimulation measures
the electrical activity of the muscle upon stimulation. Antibody testing is done in order to
identify the presence of anti-VGCC antibodies.
Electromyography results usually show a decrease in compound motor action potential
(CMAP). Repetitive nerve stimulation initially shows a small amount of electrical activity
in the muscle. After high frequency repetitive stimulation or exercise, there is increased
activity in the muscle.
Anti-VGCC antibodies are detectable in approximately 85% of LEMS patients and when
detected they are highly specific for the condition. This is because anti- VGCC
antibodies are found in LEMS with SCLC and in LEMS without cancer association.
Screening for SCLC is a very important part of the diagnostic workup for LEMS. A chest
CT (and sometimes FDG-PET) scan will usually form the basis of this screening.
Depending on the risk profile, a negative initial screen will be repeated at suitable time
intervals. A recently discovered tumor marker antibody directed against SOX, which is
found in 65% of SCLC LEMS patients as opposed to only 5% of non-tumor LEMS
patients, may help guide clinical practice in the future.