Swartz Kong - Amyotrophic lateral sclerosis (Indonesia) Posted on July 31, 2013

Name: Swartz Kong 
Sex: Female
Country: Indonesia
Age: 62 years
Diagnoses:  1. Amyotrophic lateral sclerosis 2. Hypertension 1 level average risk
Admission Date: 2013-06-20
Days Admitted to the Hospital: 28

Before treatment:
The patient suffered from glossolalia in 2010 without any obvious reason. Afterwards, the patient suffered from coughing while drinking and difficulty swallowing, along with fatigable post exercises. Left limb suffered from weakness and fasciculation. She went to many hospitals, but did not get a clear  diagnosis. With the disease progressing gradually, the patient had obvious dysarthria, difficulty swallowing and excessive salivation. She only could be on a liquid diet. She also had muscle fibrillation and muscle weakness in the left upper limb. She had difficulty swallowing in recumbent position. She was diagnosed with Amyotrophic lateral sclerosis. She took Riluzole for treatment, but the effect was not good. The disease was clearly aggravated, and the speech disorder was aggravated too. Almost everything she said was not understood by others. She only could communicate with others by writing. She had difficulty swallowing and could not eat using her mouth. She received gastrostomy indwelling gastric tube. Before the treatment, the patient had asyndesis, salivation, difficulty breathing, weakness and muscle atrophy. She could not fully lift herself up or take care of herself. For instance she had difficulty turning over, was unable to sit up from recumbent position, and needed assistance to wash herself or get dressed.

Nervous System Examination:
Swartz Kong was alert and her mental facilities were good. Her memory, calculation abilities and orientation were all normal. Both pupils were equal in size, the diameter was 3mms. Both eyeballs could move flexibly and the pupils reacted normally to light stimulus. The forehead wrinkle pattern was symmetrical. She was fully capable of closing her eyes with ease. The bilateral nasolabial sulcus was equal in depth. She was unable to stick out her tongue. There was obvious atrophy and fibrillate in the tongue. There was no deflection when she showed her teeth. There was air leakage when she expanded her cheeks. There was weakness when she raised her soft palate. The pharyngeal reflex existed. She had an increase in salivation and would cough while drinking. She had difficulty swallowing. Her muscles were weak while chewing or coughing. This was accompanied by obvious dysarthria. The muscle strength of both lower limbs was level 4. The muscle strength of the right upper limb was level 4. The adduction strength of the closest end of the left upper limb was level 3+. And the abduction strength of the closest end of the left upper limb was level 2. The adduction strength of the farthest end of the left upper limb was level 3+. And the abduction strength of the farthest end of the left upper limb was level 2. The power of the left hand to hold an object was level 2. The muscle tone of all four limbs was almost normal. There was obvious atrophy in the bilateral shoulder girdle, bilateral muscle of arms, bilateral size of thenar muscle and bilateral metacarpophalangeal muscle groups. The tendon reflex of the left upper limb was not elicited. The tendon reflex of the right upper limb and bilateral lower limbs was almost normal. The abdominal reflexes were normal. Bilateral palm jaw reflex was positive. Bilateral Hoffmman sign and Rossilimo sign were negative. Bilateral Babinski sign was neutral. The deep sensation and shallow sensation, using loose measures, were normal. She was unable to finish the finger-to-nose-test on her left side because of insufficient muscle strength, but she was able to finish the finger-to-nose-test on her right side. She could point with her left thumb, forefinger and middle finger. She was able to finish the heel-knee-shin test. There were no signs of meningeal irritation.

Treatment:
We initially gave Swartz Kong a complete examination, and she was diagnosed with amyotrophic lateral sclerosis. She received treatment to improve her blood circulation in order to increase the blood supply to the damaged neurons, to repair the damage to the neurons and to nourish them. She also received treatment to regulate blood pressure and discontinue use of a non-invasive ventilator for breathing. This was accompanied by daily physical rehabilitation training.

Post treatment:
The patient's blood pressure is under control and the level is almost normal. Her pronunciation is slightly clearer and parts of her words can be distinguished. The muscle strength of her tongue is stronger than before. The tongue can move around flexibly. She can raise her soft palate more easily than before. Her ability to swallow has improved. Her salivation has been reduced. The muscle strength of her left upper limb is slightly better. The adduction muscle strength of the closest end of the left upper limb is level 3+. The abduction muscle strength of the closest end of the left upper limb is level 3. The adduction muscle strength of the farthest end of the left upper limb is level 3+. The abduction muscle strength of the farthest end of the left upper limb is level 3. The power of the left hand to hold an object is level 3.