Kyaw Myint Oakkar - Duchenne muscular dystrophy (Burma) Posted on July 30, 2012

Name: Kyaw Myint Oakkar          

Sex: Male

Country: Burma

Age: 7

Diagnosis: Duchenne muscular dystrophy (DMD)

Admission Date: May 20, 2012

Days Admitted to Hospital: 28

Kyaw's family noticed that his walking gait had become abnormal about three and a half years ago. Additional symptoms soon developed such as weakness in the legs which made it very difficult for him to walk, and an enlargement of the muscles in both legs, so his parents took him to their local hospital for treatment. He was given a muscle biopsy and the results showed creatase zymogram levels that were higher than normal. Progressive Duchenne muscular dystrophy was considered. Kyaw's parents didn't seek out treatment for him at the time because the symptoms did not affect his daily life. But eventually the symptoms got worse and Kyaw was unable to walk or run normally and he would stand on the tips of his toes when he stood up. There was Achilles tendon contracture. Kyaw also had a minor learning disability.

Admission PE:

The mucous membrane throughout the body was complete with no yellow stains or hemorrhagic spots on the skin. The respiratory sounds in both lungs were clear, with no dry or moist rales. Through auscultation it was determined that the heart sounds were strong. The cardiac rhythm was normal, with no obvious murmur. The abdomen was smooth and soft, with no tenderness or rebound tenderness. The liver and spleen were not palpable under the ribs. There was mild atrophy in the shoulders and pelvic girdle. The shoulders were winged-shaped. Bilateral gastrocnemius pseudohypertrophy. The bilateral Achilles tendon had mild contracture, Gower sign. Kyaw had difficulty with standing and walking. He would stand on the tips of his toes while walking and couldn't walk up or down stairs.

Nervous System Examination:

Kyaw was alert and in good spirits. His speech was fluent. His responses were slow. The memory, calculation and attention abilities, orientation were slightly poor. Both pupils were equal in size and round, their diameter was 3.0mms. Both pupils had normal reaction to light stimulus. Both eyeballs had flexible movement. The forehead wrinkle pattern was symmetrical. The closing ability of the eyes was strong. The muscle strength of the soft palate was strong and the lifting was symmetrical. The muscle strength of the cheeks was strong and there was no air leakage when the cheeks were expanded. The muscle strength of both upper limbs was level 4. The holding power of both hands was level 4-. The muscle strength of both lower limb' proximal-end was level 4- and the muscle strength of the distal-end was level 3. The muscle tone of all four limbs was slightly low. The tendon reflexes of all four limbs were not elicited. The abdominal reflexes were normal. The bilateral palm jaw reflex was negative. The bilateral Hoffmann's sign and Rossolimo's sign were negative. The bilateral Babinski's sign was negative. The bilateral shallow sensation, deep sensation and fine sensation were normal through coarse measurement. The bilateral finger-to-nose test, digit opposition test and rapid rotation test results were almost normal. The patient was unable to finish the heel-knee-shin test.

Treatment: 

Kyaw received treatment from May 30, 2012. We initially gave Kyaw a complete examination, and he was diagnosed with Duchenne muscular dystrophy (DMD). He received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and to nourish the neurons and muscles. He also received nutritional support, treatment to protect the liver functioning and treatment to protect the myocardium. This was combined with daily physical rehabilitation training.

Post-treatment:

Kyaw's condition has improved. The responses are more sensitive. The memory, calculation abilities, attention ability and orientation are better than before. The patient gained some weight and his height increased. At present: height:117cm, weight: 22Kg. The liver function as improved and the kinase level has been reduced. After treatment, the muscle volume of the shoulders, pelvis and all four limbs increased. The pseudo hypertrophy of the bilateral gastrocnemius has been alleviated. The muscle strength and endurance of all four limbs, shoulders and pelvis has increased. The muscle strength of both upper limbs has increased 0.5 levels and reached level 4+. The holding power of both hands has increased 0.5 levels and reached level 4. The muscle strength of both lower limbs increased 1 level. At present, the muscle strength of both lower limbs' proximal-end is level 5- and the distal-end is level 4-. The contracture of both Achilles' tendons is not as severe and the right Achilles' tendon has had more progress. The patient's lower limbs are able to finish the heel-knee-shin test. At present, the patient can turn over and get up quickly. He can crawl and walk faster than before. And the time period of crawling and walking also increased. The patient can walk up and down 20 stairs. The endurance of all four limbs has increased.