Clinton Frank - ALS (Cyprus) Posted on July 2, 2014

Name:Clinton Frank               
Sex: Male
Country: Cyprus
Age:47 years
Diagnosis: Amyotrophic lateral sclerosis
Date: May 18, 2014
Days Admitted to Hospital: 18 days

Before treatment:
The patient suffered from walking difficulty 2 years ago without obvious inducement. The disease aggravated gradually. About 6 months later, the patient suffered from weakness of right upper limb too. He had weak muscle strength to raise arm and was diagnosed with amyotrophic lateral sclerosis in a local hospital. He took Riluzole for treatment. But the disease progressed gradually. The patient suffered from weakness of his four limbs and obvious muscle atrophy. He also had speech difficulty and dysphonia. The speech was slower than normal.

From onset of disease, the patient had poor spirit. The sleep quality was poor. He sleeps 4 hours each day. He had poor appetite. He had normal defecation. His weight reduced about 5kg in recent 6 months. There was no genetic disease.

Admission PE:
Bp: 116/84mmHg; Hr: 92/min, temperature 36.3 deg. Br: 18/min. Height: 166cm, weight: 77Kg. His development and nutrition were normal. His body type was normal. His skin and mucosa were normal, with no yellow stains or petechia. The breathing movement of both lungs was weak. The respiratory sounds in both lungs were clear, with no obvious 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.

Nervous System Examination:
Clinton Frank was alert and was in good spirits. He needed great effort to speak and it was vague. 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. Both eyeballs had slight horizontal nystagmus. 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 his oral cavity. There was no obvious atrophy in tongue. The movement of tongue was not flexible. He showed his teeth without deflection. He was able to raise his soft palate. The uvula was shifted to left side. His swallowing ability was weaken. The neck was soft. He had strong muscle to raise and turn head. The muscle strength to shrug shoulders was at level 4. There was muscle atrophy in both upper limbs. The adduction of right upper limb's near-end was at level 2. The abduction of right upper limb's near-end was at level 4-. The muscle strength of right upper limb's far-end was at level 3. The muscle strength of right hand was weak. The grasp power of right hand was at level 3-. The adduction of left upper limb's near-end was at level 4-. The abduction of left upper limb's near-end was at level 3. The abduction of left upper limb's far-end was level 3. The grasp hold power of left hand was at level 3-. The muscle strength of both lower limbs was at level 4-. The muscle tone of both ankle joints was slightly higher than normal. The muscle tone of his four limbs was normal. But he always suffers from muscle spasm after exercises. The tendon reflex of his lower limbs was active. Bilateral abdominal reflex was weak. Bilateral ankle clonus was negative. Bilateral palm jaw reflex were positive. Bilateral Hoffmann sign was positive. Bilateral Babinski sign was positive. The deep sensation and shallow sensation, using loose measures, were normal. He was unable to finish the finger-to-nose test, digital opposition test, the rapid rotation test and the heel-knee-shin test. There were no signs of meningeal irritation.

Treatment:
We initially gave Clinton Frank a complete examination. He was diagnosed with Amyotrophic lateral sclerosis and Abnormal liver function. After admission, the patient's thyroid gland level was higher than normal. The patient received the relevant examinations. He was diagnosed with Hyperthyroidism. He received treatment for nerve regeneration and to activate stem cells in vivo. At the same time, 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 correct hyperthyroidism and protect liver. He received Non-invasive ventilator for breath. The ventilator was ST mode. The parameter for respiratory rate was 10/min, shows suction pressure 10 and exhale positive airway pressure 5. This was accompanied with daily physical rehabilitation training. 
  
Post treatment:
The patient's condition has improved. He sleeps 5 to 7 hours every night. He has better appetite. The energy and muscle strength has improved too. The pronunciation is clearer than before. The thorax can expand larger than before. The muscle strength of the limbs had increased too. The adduction of right upper limb's near-end is at level 3. The abduction of right upper limb's near-end is at level 4. The muscle strength of right upper limb’s far-end is at level 3+. The grasp power of right hand is at level 4-. The adductor muscle strength of left upper limb's near-end is at level 4, and the abductor muscle strength of left upper limb's near-end is at level 4-. The grasp power of the left hand is at level 4. The muscle strength of both lower limbs is at level 4+. The spasms of muscle after exercises have been alleviated.