. ▁These ▁syn apt ic ▁ves icles ▁contain ▁ac et yl ch oline , ▁which ▁is ▁released ▁into ▁the ▁syn apt ic ▁c left ▁and ▁stim ul ates ▁the ▁ac et yl ch oline ▁re cept ors ▁on ▁the ▁mus cle . ▁The ▁mus cle ▁then ▁contract s . ▁ ▁In ▁LE MS , ▁ant ib od ies ▁against ▁V G CC , ▁particularly ▁the ▁P / Q - type ▁V G CC , ▁decrease ▁the ▁amount ▁of ▁calci um ▁that ▁can ▁enter ▁the ▁n erve ▁ending , ▁hence ▁less ▁ac et yl ch oline ▁can ▁be ▁released ▁from ▁the ▁neur om us cular ▁j unction . ▁A part ▁from ▁ske let al ▁mus cle , ▁the ▁autonom ic ▁nerv ous ▁system ▁also ▁requires ▁ac et yl ch oline ▁ne uro trans mission ; ▁this ▁explains ▁the ▁occurrence ▁of ▁autonom ic ▁sympt oms ▁in ▁LE MS . ▁P / Q ▁voltage - g ated ▁calci um ▁channels ▁are ▁also ▁found ▁in ▁the ▁c ere bell um , ▁explaining ▁why ▁some ▁experience ▁problems ▁with ▁coord ination . ▁The ▁ant ib od ies ▁bind ▁particularly ▁to ▁the ▁part ▁of ▁the ▁re ceptor ▁known ▁as ▁the ▁" domain ▁III ▁S 5 – S 6 ▁linker ▁pe pt ide ". ▁Ant ib od ies ▁may ▁also ▁bind ▁other ▁V G CC s . ▁Some ▁have ▁ant ib od ies ▁that ▁bind ▁syn apt ot ag min , ▁the ▁protein ▁sensor ▁for ▁calci um - reg ulated ▁ves icle ▁fusion . ▁Many ▁people ▁with ▁LE MS , ▁both