Tomche Kostadinoski - Duchenne muscular dystrophy (Macedonia) Posted on July 2, 2014

Name: Tomche Kostadinoski            
Sex: Male
Country: Macedonia
Age:14 years
Diagnosis: Duchenne muscular dystrophy
Date:May 17, 2014
Days Admitted to Hospital: 28 days

Before treatment:
The patient suffered from walking difficulty 9 years ago and the disease aggravated gradually. He lost his walking ability 7 years ago and suffered from weakness of upper limbs 3 years ago. After the gene test, he was diagnosed with Duchenne muscular dystrophy. Then he received rehabilitation training. The disease aggravated gradually. At present, the patient is kept in bed. He suffered from malformation of his four limbs and spine. The muscle strength of his four limbs was at level 1-2. The muscle tone of his four limbs was low.

From the onset of disease, the patient had good spirit and normal defecation. There was no genetic disease.

Admission PE:
Bp: 140/87mmHg; Hr: 125/min, temperature: 36.9deg. Height: 142cm, weight: 48Kg. The skin and mucosa were normal, with no yellow stains or petechia. Through auscultation, the respiratory sounds in both lungs were clear, with no dry or moist rales. The heart sounds were strong, the cardiac rate was normal, with no obvious murmur in each valves. The abdomen was enlarged and soft. There was no pressing pain or rebound tenderness. We didn’t touch the liver or spleen under the ribs. There was tendon contracture in bilateral elbow joints, wrist joints, knee joints and ankle joints. Bilateral elbow joints and knee joints couldn't be straightened completely and presented with 125 degrees. Bilateral wrist joints had adduction malformation. The fingers of both hands were bent slightly and couldn't be straightened. The action of bilateral ankle joints was limited; the inward rolling and dorsal flexion were limited. Both feet dropped. The lumbar vertebra was bent to left side obviously.

Nervous System Examination:
Tomche Kostadinoski was alert, and his speech was fluent. His spirit was good. His memory, calculation ability, comprehension and orientation were all normal. Both pupils were equal in size and round, the diameter was 3.0mms. Both pupils were sensitive to light stimulus. Both eyeballs had flexible movement. The forehead wrinkle pattern was symmetrical. The ability to close his eyes was strong. The bilateral nasolabial sulcus was equal in depth. The tongue was centered in the oral cavity, with no teeth deflection. There was no air leakage when he drummed cheeks. He could raise the soft palates strongly. The muscle strength of his neck was at level 2. He could side turn his neck at 30 degrees. The muscle strength to shrug his shoulders was at level 1. The muscle strength of the upper limbs' near-end was at level 1. The muscle strength of both upper limbs' far-end was at level 2. The muscle strength of both lower limbs was at level 1. The muscle tone of his four limbs was low. He was unable to turn over, sit-up, stand or walk. The tendon reflex and abdominal reflexes of his four limbs was not elicited. Bilateral pathological character were negative. The deep, shallow sensation and epicritic sensation were normal through loose measure. He was unable to finish the finger-to-nose test, digital opposition test, the rapid rotation test or the heel-knee-shin test. There were no signs of meningeal irritation.

Treatment:
We initially gave Tomche Kostadinoski a complete examination. He received treatment for nerve regeneration and to activate stem cells in vivo. He received treatment to enhance his liver function, reduce creatase, to nourish the nerves, to promote nerve regeneration and also to stabilize organ function. He also received treatment to improve the blood circulation in order to increase the blood supply to the damaged neurons. This was accompanied with physical rehabilitation treatment. The laboratory test showed: the blood routine: HGB 113g/L. He was diagnosed with mild anemia. He received treatment to complement iron agent.

Post-treatment:
The patient's condition has improved. The anemia has been alleviated. The joint contracture of his four limbs has been alleviated. The angle of bilateral elbow joints is about 145 degrees. The degree of bilateral knee joints is about 150 degrees. The muscle strength to shrug his shoulders has increased. The muscle strength of both upper limbs has improved. The muscle strength of upper limbs' near-end has reached level 1+ and far-end is at level 3. The grasp power of both hands has improved. The grasp power of left hand is at level 3 and right hand is at level 2+. The muscle strength of both lower limbs is at level 2+. When both his lower limbs do translational motion, his knee joints can lift off bed surface. The creatase level has reduced obviously than before. He does not always feels tired when he does rehabilitation training. The stamina is enhanced than before. 
 

 E-mail:

Date:2015-4-16

Hello Dr. Wang

I'm sending the latest results from Tomche.
Do we need to continue his treatment as planned? Since some of the medications are due to be stopped according to the list of medications that you have provided to us. 

Tomche feels good. He says he can do things that he was not able to do before. At least he can sit on his own without being afraid of falling. And he can move his toes and his foot a bit. For now he seems fine. The improvements are minimal according to his condition.

If you need more details about his condition you can give directions on what to notice.

Best regards
Aleksandar