Edwiin Bush - ALS (Canada)

Name: Edwiin Bush    

Sex: Male

Age: 58 years old

Country: Canada

Diagnoses: 1.Amyotrophic lateral sclerosis 2.Hyperlipidemia 3. Abnormal liver function

Admission Date: 2013-12-15

Days Admitted to the Hospital:28

Before treatment:
The patient suffered from weakness of his right hand 6 months ago. His right hand suffered from weakness, stiff and grip strength reduction. He had difficulty with picking objects. He went to a local hospital and received EMG. He was diagnosed with amyotrophic lateral sclerosis. He received Riluzole 50mg two times each day. But the effect was not obvious. The muscle strength of his right wrist, right forearm and right arm were reduced gradually. This was accompanied with atrophy in size of the thenar muscles and lumbricals. There was also atrophy in his forearm, upper limb and deltoid muscle. The atrophic muscle group had large fasciculation and accompanied with pain. Then his left upper limb and both lower limbs suffered from weakness and muscle atrophy. The disease was aggravated gradually. His walking gait presented with drag gait.

Before the treatment, the patient had difficulty with picking object. His daily life activity was limited gradually. There was no breathing difficulty or swallowing difficulty. He had no difficulty with speech, anaesthesia or hyperesthesia. From onset of disease, he had normal spirit and regular diet. His defecation was normal. His weight was reduced to 3Kg. There was no similar disease in his family members.

Admission PE:
Bp: 120/80mmHg; Hr: 80/min. His development and nutrition were normal. His body type was normal. His skin and mucosa were normal, with no yellow stains or petechia. There was no swelling in the lymph gland. The respiratory sounds in both lungs were clear, with no obvious dry or moist rales. The rhythm of his heartbeat was normal, with no obvious murmur in the valves. His abdomen was flat and soft, with no pressing pain or rebound tenderness in the abdomen. The doctor did not touch the liver or spleen under the ribs. There was no swelling in both lower limbs. The test showed serum cholesterol was higher than normal. The transaminase in liver was higher than normal.

Nervous System Examination:
Edwiin Bush was alert and was in good spirits. 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 at the center of oral cavity and the tongue could move to the left and right side. There was mild atrophy in the tongue's right side. There was fibrillation in tongue. There was mild air leakage when he drummed his cheeks. He was not able to raise his soft palate due to muscle weakness. The muscle strength of left upper limb's near-end was at level 4 and the far-end was at level 3. The muscle strength of right upper limb's near-end was at level 1 and the far-end was at level 0. The grasp power of left and was at level 3-. The grasp power of right hand was at level 0. The muscle strength of both lower limbs was at level 4+. There was muscle atrophy in the thenar and hypothenar muscles of the hand and lumbricals, and the right side was more severe. In addition, he had muscle atrophy and large fasciculation in the right forearm and upper arm. The tendon reflex of his four limbs was active. Bilateral abdominal reflex was normal. Bilateral jaw reflex and palm jaw reflex were negative. Bilateral Hoffmann sign and Rossilimo sign were negative. Bilateral Babinski sign was negative. The deep sensation and shallow sensation were normal. He was able to finish the finger-to-nose-test and the heel-knee-shin test in a stable manner. Right side had difficulty with the digit opposition test and the rapid rotation test. There were no signs of meningeal irritation.

Treatment:
We initially gave Edwiin Bush a complete examination. He received treatment to improve his blood circulation in order to increase the blood supply to the damaged neurons and to nourish them. He also received treatment for nerve regeneration. He received Non-invasive ventilator for breath discontinuously. The blood oxygen was maintain between 96% and 98%. This was accompanied by daily physical rehabilitation training.

Post treatment:
The patient's blood lipid and liver function has been restored to normal level. The atrophy in the tongue is not severe as before. The fasciculation in the tongue has disappeared. There is no air leakage when he drums his cheeks now. The muscle strength to raise soft palate has improved. The muscle strength of four limbs has improved. The muscle strength of left upper limb's near-end is at level 4+. The muscle strength of left upper limb's far-end was at level 4. The muscle strength of right upper limb's near-end was at level 2 and the far-end was at level 1. The muscle strength of both lower limbs was at level 4+. He walks more easily. The exercise tolerance has increased obviously.