John-Amyotrophic Lateral Sclerosis-(UK)

Name: John
Sex: Male
Nationality: UK
Age: 57
Diagnosis: 1. Amyotrophic Lateral Sclerosis (ALS) 2. Diabetes II
Date of Admission: April 28th, 2016
Treatment hospital/period: Wu Medical Center/13 days

Before treatment:
John always felt tired beginning about 3 years ago, he felt weakness in his left shoulder 15 years ago, and he didn’t know why, then his left upper limb, then his right upper limb and both lower limbs were involved, he had muscular atrophy in different degrees in all four limbs. He began to speak unclearly and have swallowing problems. He went to the local hospital and was diagnosed with amyotrophic lateral sclerosis. The doctor prescribed Riluzole and Citalopram, but his condition continually worsened. His upper limbs were weaker, and he could hardly speak and swallow. He walked slowly beginning 3 months ago, his balance deteriorated, and it was hard for him to walk up and down stairs. He began feeling dizzy when he moved, about two months ago. He currently gets easily tired and has difficulty walking more than 20 meters without assistance. His upper limbs were not able to move.

John was in good spirits since the onset of the disease, his sleeping pattern and diet were normal. He was put on medication to help him defecate. His urination was normal.

Admission PE:
Bp: 130/89mmHg; Hr: 67/min. Br: 20/min. Temperature: 36.2 degrees. Height: 170cms, weight: 86kg. John felt dizzy when he changed his body positions. His body type and nutritional situation were normal. There were no yellow stains or petechia on the skin or mucous. The color of his lips was normal. There was no pharyngeal congestion. The tonsils were not enlarged. His bony thorax was symmetrical. When he breathed, the expansion of the lungs was weak. The respiratory sounds in both lungs were clear, with no dry or moist rales. There was no precordial prominence. The rhythm of the heartbeats was powerful and regular. There was no obvious murmur in the valves. The abdomen was soft and flat with no pressing pain or rebound tenderness. The liver and spleen were normal. The shifting dullness was negative. He had spinal physiological curvature. There was no edema in the lower limbs. The anus and external genitalia were not examined. 

Nervous System Examination:
John was alert and in good spirits. He was not able to speak clearly and he had a hoarse voice. His memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, the diameter was 3mms. Both eyes had sensitive responses to light stimuli. Both eyeballs could move freely. The nasolabial fold and forehead wrinkle pattern were symmetrical. There was no nystagmus. The tongue was centered in the oral cavity. There was no tooth deflection. The tongue muscle was weak and it had difficulty touching the inside of the cheeks. The cheeks could be expanded well. He chewed powerful, both soft palates could be raised, but the strength was weak. He had difficulty swallowing and would often choke when drinking water. The bilateral supraspinatus muscle, infraspinous muscle, triangular muscle, triceps muscle, biceps brachii, thenar muscle, hypothenar muscle and interosseous muscles in the hand were underdeveloped to difficult degrees. The neck was soft, he was not able to turn his neck around or shrug his shoulders. The muscle power of the upper limbs was at level 1, the muscle power of the lower limbs was at level 4. He was able to sit up with someone’s help, he was able to stand and walk by himself, but he took long steps and walked slowly. It was difficult for him to go up or down the stairs. The muscle tension of all four limbs was normal. The bilateral biceps reflex and radial periosteal reflex were weak. The triceps reflex was abnormal. The patella tendon reflex was normal. The bilateral palm jaw reflex was positive. The bilateral Hoffmann’s sign was negative, the bilateral Rossolimo’s sign was negative. The bilateral Babinski’s was negative. He was not able to complete the finger-to-nose test or rapid rotation test. His right hand and left little finger were not able to complete the finger-to-finger test, the other four fingers of his left hand had difficulty performing the test. The heel-knee-tibia test was normal. The meningeal irritation sign was negative.

Treatment:
John received the relevant examinations and was diagnosed with 1. amyotrophic lateral sclerosis, 2. Type 2 diabetes. John received 3 neural stem cell injections and 3 mesenchymal stem cell injections to improve his blood circulation, repair his damaged nerves, activate the new stem cells in his body and nourish the neurons. We also gave him daily physical rehabilitation.

Post-treatment:
After two weeks of treatment, John was able to breathe better, the respirations were stronger. He spoke more clearly, especially when he counted numbers. He had less fasciculation; there was more power in all four limbs. The muscle power of the right upper limb was at level 2, the muscle power of the left upper limb was at level 1+, and the lower limbs were at level 4+. He was able to stand up from the sitting position, his walking position was better and he was able to take longer strides when he walked.