Mr.Izadi-Hereditary Inclusion Body Myopathy-(Israel)

Name: Mr. Izadi
Sex: Male
Nationality: Israeli
Age: 37Y
Diagnosis: Hereditary Inclusion Body Myopathy(HIBM)
Discharge Date: 2018/05/15

Before treatment:
The patient had foot drop 7 years ago, he was unable to run or walk well and a few months later he couldn’t raise his legs. He was diagnosed by a local hospital with HIBM. He took prescription medicine but showed no improvement. The muscle power in his back and waist decreased, it was hard for him to sit up or stand up and he also had weakness in his arms. The muscle volume in his four limbs is decreased. He always felt tired and he felt short of breath after exercise. At present he has an abnormal gait and needs help to go up and down stairs. He is able to sit up, turn over and get up from bed by himself.
His spirit, diet and sleep are normal. He has normal urination and defecation functions.

Admission PE:
Bp: 129/83mmHg, Hr: 83/min, breathing rate: 18/min. body temperature 36.3. Blood oxygen concentration was 91-92%. Height 180cm, weight 80Kg. The patient's skin was normal with no bleeding or yellow stains and no tonsil swelling. The chest development was normal, the respiratory sounds in both lungs were clear and there were no dry or moist rales. The heart beat was powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was flat and soft with no masses or tenderness. Liver and spleen were normal by touch and there was no edema of the legs.

Nervous System Examination:
Patient was alert and had clear speech. His memory, orientation and calculation abilities were normal. Both pupils were equal and round, diameter of 3.0mm, react well to light, the eyeballs can move freely and with no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical, he could close eyes powerfully. He could make his tongue extend out normally, showing teeth was normal and he could bulge his cheeks as normal. The bilateral soft palate can life powerfully. He could turn his neck and shrug powerfully. The muscle volume of the arms was decreased, there was mild muscle atrophy of the hands palmar interossei muscles. The arm proximal side muscle power was 4- degrees, distal side muscle power was 4 degrees. The right leg proximal side muscle power was 3- degrees, distal side muscle power was 3+ degrees. The left leg muscle power was 3- degrees. Using only his right leg he could stand  for 3 seconds, he could not do so using his left leg. The 4 limbs muscle tone were low and 4 limbs tendon reflex was decreased. The abdominal reflex was normal. Bilateral palm-jaw reflex was negative, bilateral Hoffmann sign and Rossilimo sign were negative, the Babinski sign was positive, his sensory system was normal by gross measure. Finger opposite movement, fast alternate movement and finger to nose test were normal. He could not perform the heel-knee-tibia test because of weakness. The meningeal irritation sign was negative.

Treatment:
After the admission he received 3 nerve and muscle regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged nerves and muscle cells, replace dead cells, nourish nerves, regulate his immune system and improve blood circulation. This was done with rehabilitation training.     

Post-treatment:
After 15 days treatment his motor functions improved 30%, he could raise his arms easier, could grasp better, his leg muscle power increased around one  level and the abduction ability increased. He could now walk better and longer. He could stand with one leg for 10 seconds.

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