Sibony-Amyotrophic Lateral Sclerosis-(Israel)

Name: Sibony
Sex: Male
Nationality: Israeli
Age: 50Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)

Before treatment:
The patient was unable to speak clear 2 years ago, and then it was hard for him to swallow food, he went to local hospital and diagnosed with ALS, 7 months ago, his left side body was weak, and then his right side body was weak, his condition was bad he also had muscular atrophy, 3 months ago his lower limbs were weak, he fell down a lot, he was able to walk with some help, his exercise tolerance was bad, it was easy for him to be tired. He went to India 2 months ago and did autologous stem cell transplantation but ineffective. For now, he is able to stand, walk and turn over by himself, but he is unable to sit up by himself, he needs help with eating, wearing and washing. He is unable to chew, so he only eats small pieces of food, sometimes he chokes when drinking, his breathing function is weak.
His mood is not good, sometimes he is anxiety and upset, he eats less and takes longer time to eat, his urination function is normal, he defecates once in 2 days, he lost 15 kgs.

Admission PE:
Bp: 125/76mmHg, Hr: 85/min, breathing rate: 19/mim, body temperature: 36.7 degrees. 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, chest movement decreased with his breathing, the respiratory sounds in both lungs were weak, of the lungs lower parts were very weak, only can heard when he had deep breath, 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 both lower limbs.

Nervous System Examination:
Patient was alert and mental status was good,dysarthria, he only can make few pronunciation such as “air”,the memory, orientation and calculation ability were normal. Both pupils were equal in size and round, diameter as 2.5mm, react well to light, eyeballs can move freely. Bilateral forehead wrinkleand nasolabial grooveissymmetrical,he can tongue out to lip side, with poor tongue movement. Show teeth is normal. His tongue can not touch against the cheek or palate as normal. His chewing ability is weak, can not bulge the cheek, the bilateral soft plate can lift powerfully, he can close eyes powerfully. Neck is soft, he can not turn head powerfully, he can not shrug. The left arm proximal muscle power is 2- degree, if distal side is 3- degree, the left hand grip force is 2 degree. The right arm proximal side muscle power is 2- degree, of distal side is 3 degree. The right hand grip force is 2 degree. Muscle power of lower limbs is 4 –degree. There are obvious muscle atrophy o the bilateral shoulder girdles, upper limbs, thenar muscles, interosseus muscles and intercostal muscles. Muscle volume of lower limbs are very bad, muscle tone are normal, no obvious fasciculation.The bilateral biceps reflex, radial periosteal reflex and triceps reflexare normal, the lower limbs patellar tendon reflex andAchilles tendon reflex are hyperactive.The Palm-jerk reflex of both sides are positive, Rossilimo sign of both sides are positive, the bilateral Hoffmann sign are positive. The Babinski sign of both sides are positive. Patient can not perform the finger to nose test and fast alternate movement, he can only done the finger opposite movement with his index fingers, the heel-knee-tibia test is less stable, the Meningeal irritation sign is negative.

After the admission, he received related examinations and diagnosed with Amyotrophic Lateral Sclerosis and Frequent ventricular premature beat ( FVPB ). 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 13 days’ treatment, his speech was much clearly than before, we can distinguish the pronunciation much easier. He can bulge the cheek and keep for 15 seconds, he can tongue out 1cm out of lips, the muscle power of his upper limbs was increased 1 level, he was able to raise arms over head, his grasp force of both hands increased. His fingers were flexible, he could use computer and drink water. The muscle power of lower limbs was increased to 4+ level, he was able to walk longer by himself. He had the ability of going up stairs.

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