Keith Kitson-Amyotrophic Lateral Sclerosis-(UK)

Name: Keith Kitson 
Sex: Male
Nationality: UK
Age: 73Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS) 2. Hypertension (1 degree)

Before treatment:
The patient felt hard to swallow 2 years ago, he had language problems 1 year ago, he spoke slowly and unclear, he went to local hospital and did MRI and EMG, he was diagnosed with ALS. He took Riluzole(50 mg, q12h), after that, he had respiration problems, he also had fasciculation. His upper limbs were weak 6 months ago, for now he is able to take care of himself, he has problems with swallowing and respiration, he could only eat small pieces of food and he has a lot of saliva, he is unable to speak clear, he could only speak single words, his upper limbs are weak. He wants a better life so he comes to our hospital.
His spirit and sleep are good. His appetite is not good. He urinates 4 times each night, he has problems with defecations sometimes. He has lost 20kgs.

Admission PE:
Bp: 151/94mmHg, Hr: 79/min, breathing rate: 20/min, body temperature: 36 degrees. Height: 166cm, weight: 65Kg. Nutrition status is good, normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion, the secretions within his mouth increased. Chest develop is normal, while the chest movement range decreased when he was breathing, the respiratory sounds in both lower lungs were weak, 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, the dorsalis pedis artery pulse was normal.

Nervous System Examination:
Patient was alert and mental status was good, dysarthria, slur speech, he could only pronounce some simple single syllable, 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, he can make tongue out to lips side 2-3 mm, tongue muscle atrophy. He couldshow teeth as normal. Patient could bulge the cheek for few seconds, chewing ability decreased. Bilateral soft plate can lift, uvula was in middle. There were muscle atrophy in the bilateral shoulders, upper limbs, both thenar muscles and hands interosseous muscles. Neck was soft, he could turn neck and shrug. Muscle power of right upper limb was 4+ degree, of left upper limb was 5- degree. Grip force of both hands was 5 degree. Muscle power of lower limbs was 5 degree. Muscle tone was normal. Tendon reflex of 4 limbs decreased, bilateral Hoffmann sign were negative, Babinski sign of both sides were negative. Finger to nose test, fast alternate movement and finger opposite movement were basically normal. The meningeal irritation sign was 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, nourish nerves, regulate his immune system and improve blood circulation, with rehabilitation training.

After 16 days’ treatment, his drooling reduced, appetite got better, his swallowing function improved, he ate better and took shorter time, he could speak much clearly, and he try to pronounce double syllable words, the breathing function improved, his lower lungs breathing sounds was much stronger. His limbs were much more flexible, he walked longer.

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