Irrum Yahya-Amyotrophic Lateral Sclerosis-(Pakistan)

Name: Irrum Yahya
Sex: Female
Nationality: Pakistani
Age: 47Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)

Before treatment:
5 years ago, the patient’s left leg was weakness accompanied with fasciculation on and off, her right leg was weakness later, so she went to local hospital and diagnosed with Amyotrophic Lateral Sclerosis, she received IVIG for 3 days without good effect, 1 year ago, her upper limbs were weak. At present, she is unable to walk, she uses a wheelchair, she is able to turn over by herself but she is unable to sit up or stand. Her language and swallowing functions are good. She wants a better life so she comes to our hospital.
Her spirit is good, she eats less than before, it is hard for her to sleep, and she wakes during night. Her urination and defecation functions are normal. She lost some weight.

Admission PE:
Bp: 149/98mmHg, Hr: 95/min, breathing rate: 20/mim, body temperature: 36.5 degrees. She use wheelchair to the patient room (Height and weight not measured). Nutrition status is good, normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion. Chest develop is normal, the respiratory sounds in rightlower lungs part were low, no dry or moist rales. The heart beat is strong with regular cardiac rhythm, with no obvious murmur in the valves. The abdomen was soft and plate, with no masses or tenderness. The liver and spleen were normal, shifting dullness was negative, spine column is normal, no edema in below lower limbs.

Nervous System Examination:
Patient was alert and mental status was good, the memory, orientation and calculation ability were normal. Both pupils were equal in size andround, diameter as 3.0 mm, react well to light, eyeballs can move freely. Bilateral forehead wrinkle and nasolabial groove was symmetrical, she can make tongue out as normal, her tongue muscle could move freely. Chewing ability was normal. Neck was soft, shrug ability was normal, right upper limb proximal side muscle power was 3 degree; of distal side was 4 degree, left upper limb proximal side muscle power was 3-degree, of distal side was 3+ degrees. Grip force of right hand was 3 degree, of left hand was 2 degree. She can bend right leg, her left joint can lift up to bed around 5cm, muscle tone of 4 limbs were basically normal. 4 limbs tendon reflex could not be induced by examination, bilateral Hoffmann sign, Palm-jaw reflex, Babinski sign of both sides were negative, she only could perform the finger opposite movement with index finger. She could perform the fast alternate movement slowly, patient could not perform the coordinate movement because of the weakness. The meningeal irritation sign was negative.

After the admission, she received related examinations and diagnosed with ALS. She received 3 times nerve regeneration treatment to repair his damaged nerves, replace dead nerves, nourish nerves, regulate her immune system and improve blood circulation, with rehabilitation training.     

After 17 days’ treatment, She speaks louder, her breathing function is better. Sat is 97-98%, her limbs muscle power increased, she is able to raise arms higher and grasp objects powerful, her hands are doing fine movement easier, she can sit up from lying position or roll over in bed much easier. Her legs could move on the bed and her legs are flexible.

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