Dodai Khan - Amyotrophic Lateral Sclerosis (Pakistan) Posted on December 2, 2013
Name:Dodai Khan 
Gender:Male
Age:52 years old
Nationality: Pakistan
Diagnose:1.Amyotrophic Lateral Sclerosis 2.Type 2 diabetes
Admission Date: 2013-10-28
Days Admitted to the Hospital:28
Before treatment:
In April 2012, the patient experienced weakness in strength of his thumb and index finger and he went to a local hospital. An EMG was conducted on him at the same hospital and the result indicated preliminary spinal cord anterior horn disease and it's related to diabetes. The patient's muscle strength was progressively weaker and the weakness spread from his right hand to his right shoulder and then from right toes to right hip. Six months ago, the patient went to a neurological department of an Indian Hospital and EMG was conducted on him and he was diagnosed with "Amyotrophic Lateral Sclerosis" based on the findings. He took oral medicine Riluzole 50mg twice a day and the patient's condition did not show any improvement, his condition was intensified gradually. The patient had diabetes for past 10 years.
Admission PE:
Br: 19/min. The respiratory sounds of the patient in both lungs were rough, with no obvious rales. Hr: 77/min. The heart sound was low, the rhythm of his heartbeat was normal, with no obvious murmur in the valves. He was alert and his sprit was good. His 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. He was able to close his eyes with ease. The bilateral nasolabial sulcus was equal in depth. The tongue was in the center of oral cavity. There was no atrophy in the tongue. He had strong strength to raise his soft palate. The uvula was in the center of oral cavity. The neck was soft, with strong muscle to turn head left side and right side. He also could shrug his shoulders with strong muscle. The muscle strength of left upper limb and left lower limb was at level 4. The interosseous muscle of left hand was at level 3. The muscle strength of right upper limb was at level 3. The muscle strength of right lower limb was at level 3+. The hold power of right hand and interosseus was at level 2. The muscle tone of right limb was low. The tendon reflex of left side was normal. The tendon reflex of right side was disappeared. There was paroxysmal muscle tremor in four limbs. There was muscle atrophy in right limbs and bilateral supraspinatus. Bilateral abdominal reflex was not elicited. Bilateral jaw reflex and palm jaw reflex were negative. The sucking reflex was negative. The Bilateral Hoffmann sign and Babinski sign were negative. Right side was unable to finish the finger-to-nose test, the digit opposition test and rapid rotation test. The creatine kinase in blood was measured 771IU. The blood oxygen saturation was measured as 93-95%.
The assisted examination: EMG(2012.4.10): Early spinal cord anterior horn cells disease.
Treatment:
Dodai Khan was admitted on Oct 28, 2013. We initially gave Dodai Khan a complete examination. He received treatment to improve his blood circulation in order to increase the blood supply to the damaged neurons, to repair the damage to the neurons and to nourish them. He also received treatment to protect organ function and control blood sugar. At the same time, the patient used non-invasive ventilator to increase the oxygen supply. This was accompanied by daily physical rehabilitation training.
Post treatment:
The patient's muscle strength has improved drastically. The muscle strength of his left upper and lower limbs is at level 4. The muscle mass of left supraspinatus has increased than before. Extensor muscle strength of right upper limb has reached level 4-. The right thumb can reach right forefinger. The creatine kinase in blood has obviously reduced. Blood oxygen saturation is measured as 95-98%.
