Rami A.A.Hammad-Amyotrophic Lateral Sclerosis-(Saudi Arabia)

Name: Rami A.A.Hammad
Sex: Male
Nationality: Saudi Arabian
Age: 38Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)

Before treatment:
The patient couldn’t walk well with left leg in Feb. 2015, his condition became worse in 6 months, so he went to hospital did MRI and EMG tests, he was diagnosed with amyotrophic lateral sclerosis, he took Riluzole 50mg twice a day and Baclofen 25mg three times a day, his condition got worse day by day. 6 months ago, he couldn’t move left hand or right leg well, 1 month later, he needed help with walking, the muscle power of his four limbs was decreased, especially left side, he need help with writing, showering and wearing, he wanted a better life so he wanted a better life.
His spirit, diets and sleep are good, he has constipation, sometimes, he feels pain in forehead. He put on 4 KGs in 2 years.

Admission PE:
Bp: 122/79mmHg, Hr: 59/min, breathing rate: 17/min, body temperature: 36.6 degrees. Height 168cm, weight 59.5Kg. Nutrition status is good, normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, nothroat congestion. Chest develop is normal, the respiratory sounds in both lungs were normal, 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 bulge, with no masses or tenderness. The liver and spleen were normal, shifting dullness was negative, spine column is normal, no edema in both lower limbs.

Nervous System Examination:
Patient was alert and mental status was good, clear speech while a little bit slower, his voice would get weaker once he talk for a long time, the memory, orientation and calculation ability were normal. Both pupils were equal in size and round, diameter as 3.0mm, react well to light, eyeballs can move freely, there is gross horizontal nystagmus. Bilateral forehead wrinkle and nasolabial grooveis symmetrical,he can tongue out as normal, no tongue muscle atrophy. Show teeth is normal. His soft plate can lift, chewing ability is normal. He can swallow as normal. There is mild muscle atrophy of the right shoulder girdles area, the right arms distal side, right thenar muscles. Neck is soft, shrug ability is slightly weak. Right upper limb muscle power is 4- degree, right hand grip force is 4 degree, muscle power of left upper limb is 3+ degree, left hand grip force is 4- degree. Muscle power of right leg is 4- degree, of left leg is 3- degree. Muscle tone of upper limbs is normal, of lower limbs is higher. Tendon reflex of 4 limbs is hyperactive. Bilateral Palm-jerk reflex is positive, Hoffmann sign of both sides is positive. Babinski sign of both sides is positive, he can do the finger to nose test and fast alternate movement slowly. The little finger can not perform the finger opposite movement as well, lower limbs coordinator movement was clumsy because of weakness. The meningeal irritation sign is negative.

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

After 14 days’ treatment, his language and respiration functions are improved, his body muscle power had some good improvement, upper limbs proximal side adductor muscle and abductor muscle power are 5- degree, distal side muscle power are 4+ degree. The grip force of both hands reached 5- degree. Muscle power of lower limbs increased to 4+ degree. The myoclonus of lower limbs alleviated very much, his endurance improved. He is able to walk longer.

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