Randall Watkins - ALS (USA) Posted on September 10, 2014
Name: Randall Watkins 
Sex: Male
Country: USA
Age:40 years
Diagnoses: 1.Amyotrophic lateral sclerosis 2. Hyperlipidemia
Date:August 13, 2014
Days Admitted to Hospital: 14 days
Before treatment:
The patient had an accident and parts of his lower limbs were damaged. The healing process was good after operation and he could walk normally. About 6 months later, he suffered from weakness and fasciculation of right upper limb. This was accompanied with muscle pain and the pain aggravated gradually. The disease progressed gradually and damaged the left upper limb and both lower limbs. He was diagnosed with amyotrophic lateral sclerosis. He received Riluzole for treatment. About 10 months ago, both lower limbs of the patient's was presented with muscle atrophy and muscle pain. The disease aggravated gradually and the patient couldn't walk. The patient could not speak normally in recent months. He couldn't say a complete sentence at a time. Before the treatment, the patient suffered from weakness of both upper limbs. He had difficulty to raise and the grasp ability of both hands were weak. He was limited in daily life activities. He couldn't sit-up, stand or walk by himself. He was kept in a wheelchair and walk with the wheelchair. He was unable to wear or take off clothes. He couldn't take food, brush teeth or wash face by himself. There was no obvious breathing difficulty. There was no swallow difficulty. There was no anesthesia or allergy.
From the onset of disease, the patient's mood was stable. The diet and sleep was normal. The defecation and urine was regular. His weight was reduced about 10 Kg. There was no genetic disorders.
Admission PE:
Bp: 120/80mmHg; Hr: 82/min, temperature 36.7 deg. Br: 21/min. The patient's development and nutrition were normal. His skin and mucosa were normal, without yellow stains or petechia. There was no congestion in pharynx. The respiratory sounds in both lungs were clear, with no rales. The heart sound was strong and the rhythm of his heartbeat was normal, with no obvious murmur in the valves. His abdomen was soft, with no pressing pain or rebound tenderness in the abdomen. The liver and spleen were not enlarged. There was no swelling in both lower limbs.
Nervous System Examination:
Randall Watkins was alert and his speech was slow. There was no dysarthria. His spirit was good. His memory, calculation abilities and orientation were all normal. Both pupils were equal in size, the diameter was 3.5 mm. Both eyeballs could move flexibly and the pupils reacted sensitive 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 his oral cavity. The teeth was shown without deflection. There was mild atrophy in tongue. The tongue had fibrillation. The movement of tongue was flexible to each side. He had strong muscle to raise his soft palate. The uvula was in the center of the oral cavity. There was no air leakage when he drummed his cheeks. His neck was soft. He had strong muscle strength to turn his head and shrug his shoulders. The muscle strength of both upper limbs' near-end was at level 4. The muscle strength of right upper limb's far-end was at level 3. The muscle strength of left upper limb's far-end was at level 3+. The wrist joints couldn't bend to the back. The muscle strength of bend wrist was at level 1+. Both hands could grasp and couldn't be stretched completely. The muscle strength of thumbs was weak. The muscle strength of other eight fingers was at level 3+. The muscle strength of both lower limbs was at level 3. The muscle tone of both upper limbs was low. The muscle tone of both lower limbs was normal. The tendon reflex of four limbs reduced. There was moderate muscle atrophy in bilateral (hand) fingers muscle, thenar muscles, both upper limbs' muscle group, bilateral supraspinatus and infraspinatus. The abdominal reflexes disappeared. Bilateral palm jaw reflex was negative. The sucking reflex was negative. Bilateral Hoffmann sign was negative. Bilateral Babinski sign was negative. The deep sensation and shallow sensation, using loose measures, were normal. He had difficulty with the examination of the finger-to-nose test or fingers coordinate movement (for the reason of weak muscle strength). He did the rapid rotation test in a slow manner. He had difficulty with the heel-knee-shin test. There were no signs of meningeal irritation.
Treatment:
We initially gave Randall Watkins a complete examination. The patient received treatment for nerve regeneration and to activate stem cells in vivo. He received treatment to improve his blood circulation in order to increase the blood supply, to the damaged neurons, adjust immunity and to nourish them. He also received treatment for nerve regeneration and improve immunity. At the same time, he received Non-invasive ventilator for increase the oxygen supply. This was accompanied by daily physical rehabilitation training.
Post treatment:
The patient's condition has not aggravated. The muscle strength of both upper limbs has improved slightly. The muscle strength of both upper limbs to bend inwards has increased and reached level 5-. The muscle strength of both upper limbs to outreach is at level 4. The muscle strength of wrist to dorsal stretch is level 1. The muscle strength to bend his wrist is at level 2. The muscle strength of both thumbs is at level 1 and the muscle strength of other eight fingers is at level 3+. During his stay in the hospital, the patient suffered from tinnitus. There was purulent secretion in both his ears. Further questions about the patient's medical history, doctors knew the patient suffered from tinnitus before he went to our hospital. He took antibiotic for treatment tinnitus. The recurrent of tinnitus was considered. The patient received levofloxacin hydrochloride ear drops and took amoxicillin for treatment. After treatment, the secretions stopped. The tinnitus is alleviated.
