Treatment Use of 3,4 Diaminopyridine in Congenital Myasthenia and Lambert-Eaton Syndrome

The subject population will consist of selected patients proven by genetic testing, muscle
biopsy or antibody testing to have CMS or LEMS. Consideration for entry in our clinical study
will require referral from a treating pediatrician or neurologist. Dr. Maselli will examine
patients and deem which are appropriate for neurophysiologic examinations at the University
of California, Davis Medical Center. In vitro neuromuscular recordings of anconeus muscle
biopsy material (as well as standard light and electron morphologic analysis) or
documentation of a genetic mutation associated with congenital myasthenia will be required in
some patients to confirm the diagnosis of CMS.

If a participant decides to volunteer, and if the diagnosis of Congenital Myasthenic Syndrome
(CMS) or Lambert-Eaton Myasthenic Syndrome (LEMS) has not been established, the participant
may need to undergo a muscle biopsy or a blood sampling for DNA testing. The investigators
will obtain a blood test (serum chemistry) before participants start treatment and then once
a year after the start of 3,4-DAP treatment. Participants will also have an
electrocardiograph (EKG) before starting treatment, and every 2 years after the start of
3,4-DAP treatment. All study participants will then return to the clinic once each year (or
more often if the neurologist feels it is necessary) for follow-up care.

Participants will receive treatment with the study drug until it is approved by the FDA for
use in patients with CMS or LEMS, until the investigator stops the study drug (because it
doesn't work for the participant or it is unsafe for to take), or until the study is ended
for other reasons (i.e. safety concerns are discovered, etc.), whichever comes first.
Participants will be allowed to stay on other medications for myasthenia or add other
medications to treat their condition, as necessary.

If participants have an unclear history of episodes resembling seizures as determined by the
investigator, they should not to drive or operate heavy machinery for the first 6 months of
the study.

Participants may not participate in this study if they are pregnant or breastfeeding or if
they are a woman of childbearing potential who plans to become pregnant while on the study.
It is unclear how 3,4 DAP can effect an unborn fetus. Therefore, women of childbearing
potential will have a pregnancy test prior to starting the study drug and periodically
throughout the study, if needed. Participants who think they may have become pregnant during
the study should tell the study doctor immediately.

Inclusion Criteria:

1. Proven by genetic testing, muscle biopsy or antibody testing to have CMS or LEMS.

2. Age of 3 months - 75 years old.

3. Willing to take a pregnancy test if female and of child-bearing age.

4. Available for the minimum time commitment (annual visit) required for the study.

Exclusion Criteria:

1. Pregnancy

2. History of allergic reactions to pyridines

3. History of confirmed seizures in the opinion of the study investigator, liver disease,
or cardiac arrhythmias. Subjects with a questionable history of episodes that are not
clearly seizures as determined by the investigator may participate.