Malka Turgeman-Hereditary Inclusion Body Myopathy-(Israel)

Name: Malka Turgeman
Sex: Female
Nationality: Israeli
Age: 37Y
Diagnosis: 1. Hereditary Inclusion Body Myopathy(HIBM) 2.Hypothyroidism
Discharge Date: 2018/10/14

Before treatment:
The patient had right foot drop 10 years ago, she fell down when she was walking and was diagnosed with HIBM in 2009. Her condition got worse and her left leg became weak. She was unable to go up stairs 7 years ago and she couldn’t walk 6 years ago. She did a trial of 'effects and side effects of sialic acid’ for 5 years but there was no effect so she stopped 1 year ago and 2 years ago her arms were also affected. At present she is lying on a bed and  is unable to take care of herself. She is unable to sit up, turn over her body, stand up or walk by herself. Her respiration function and language ability are normal.
Her spirit is normal, her sleep and diet are normal. Her urination and defecation functions are normal.

Admission PE:
Bp: 122/84mmHg, Hr: 71/min, breathing rate: 19/min, body temperature: 36 degrees. Nutrition status is good with normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion and her tonsils do not have swelling. Chest development was normal, the respiratory sounds in the lungs were clear and there was no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was flat and soft with no masses or tenderness. The liver and spleen were normal. There is edema of the legs and the dorsalis pedis artery pulse was weak.

Nervous System Examination:
Patient was alert and had normal mental status. Her memory, comprehension and calculation abilities were normal. Both pupils were equal in size and round with a diameter of 3 mm, the reaction to light was sensitive, there was no nystagmus and the eyeballs can move normally. The bilateral forehead wrinkle and nasolabial fold are symmetrical, she could make her tongue extend out normally and the tongue muscle could move freely. Showing teeth was normal, she could bulge her cheeks, the soft palate could lift powerfully   and she could close her eyes powerfully. The neck was soft, she could turn her neck, the shrug ability was weak. Right arm proximal side muscle power was 4- degrees, distal side abductor muscle power was 4 degrees, adductor muscle power was 3 degrees. The patient's left arm proximal side muscle power was 3- degrees, distal side abductor muscle power was 3+ degrees, adductor muscle power was 3 degrees and she could not lift the left arm well. The leg muscle power was 1 degree, she can only lift the right foot heel up from the bed around 1cm, the left heel can only lift slightly and  the feet dorsal stretch was bad. The muscle tone of the legs was higher than normal. The 4 limbs tendon reflex and Achilles tendon reflex could not be induced. Bilateral palm-jaw reflex, Babinski sign and Hoffmann sign were all negative. The finger to nose test, fast alternate movement and finger opposite movement were normal. She could not perform the heel-knee-tibia test because of weakness. The meningeal irritation sign was negative. 

After the admission she received 3 cell regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged muscle cells, replace dead cells, nourish cells, regulate her immune system and improve blood circulation. This was done along with rehabilitation training.     

After 12 days treatment her arm muscle power increased 20%, her leg movement ability improved with her right leg now able to lift off the bed around 5-8 cms. The left leg could lift up from the bed around 3 cms. The back and waist support ability got better and she could now sit up easier.

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