Ms. Green-Amyotrophic lateral sclerosis-(Pakistan)

Name: Ms. Green
Sex: Female
Nationality: Pakistani
Age: 61Y
Diagnoses: Amyotrophic lateral sclerosis; hypertension type 2; hyperlipidaemia
Date of Admission: October 31th, 2016
Treatment hospital/period: Wu Medical Center/14days

Before treatment:
Ms. Green started feeling weakness in his left hand 1 year ago; her left upper limb, right hand and right upper limb were also affected. This was accompanied with muscular atrophy. She went to her local hospital, had an MRI, EMG and other relative examinations done, she was diagnosed with amyotrophic lateral sclerosis. She was prescribed Riluzole. Her symptoms got worse, 4-5 months ago, she couldn’t speak clearly, and sometimes she choked when she drank. Her muscle power was weak in 2 months, she was unable to walk by herself, and she could walk short distances with someone’s help. At present, her upper limbs are weak, she is unable to eat or dress herself. She is unable to sit up, stand or walk by herself. She wanted better treatment so she came to our hospital.
Her spirits, diet, sleep patterns, urination and bowel movements were all good, and her weight was stable.

Admission PE:
Bp: 135/85mmHg, Hr: 78/min, body temperature: 36.5 degrees. Breathing rate is 19/min. Height: 154cm; Weight 68.5Kg. The body figure was normal. Nutrition status looks normal. There was no injury or bleeding spots on her skin or mucosa. There was no cyanosis. The pharynx had no congestion. The tonsils were not swollen. The thorax was symmetrical. The respiratory sounds in both lungs were low with no dry or moist rales. There was no precordial bulge. The cardiac beats were strong. The rhythm was regular, no obvious murmur in the valves. The abdomen was slightly uplifted, with no masses or tenderness touched. The liver and spleen were normal under palpate touch. There was no edema in the lower limbs. Shifting dullness was negative, spinal physiological bending was normal, and there was no edema in the legs.

Nervous System Examination:
Ms. Green was alert and her spirits were good. Her speech was unclear. Her memory, calculation and orientation ability were normal. Both pupils were equal in size and round, and the diameter was 3mm. They reacted quickly to light stimulus. The eyeballs could move normally and there was no nystagmus. The bilateral nasolabial fold and forehead wrinkles were equal in depth. The tongue was centered when extended. The ability of the bilateral soft palate to be raised was weak. She could close her eyes normally. The bilateral shoulder girdle, upper limb muscles, bilateral thenar muscles, and interosseous muscles of the hands had atrophy. The neck was soft. The strength of the neck to turn and the strength of the shoulders to shrug were slightly weaker. The left upper limb adductor muscle strength was at 2; the abduction muscle strength was at 1+. The right upper limb adductor muscle strength was at 2, the abduction muscle strength was at 1, and the right hand grip strength was at 2+. The left hand grip strength was at 1. The lower limb muscle strength was at 4. The muscle tone of all of the limbs was normal. The tendon reflex was active. The Babinski’s sign was positive. The rapid rotation, finger-to-finger test, and finger-to-nose test could not be completed due to muscle strength. The heel-knee-tibia test was normal, and the meningeal irritation was negative.

Treatment:
Ms. Green had examinations and the diagnosis of amyotrophic lateral sclerosis was confirmed. She received 3 neural stem cell injections and 3 mesenchymal stem cell injections to repair the damaged motor nerves, replace the dead nerves with new injected stem cells, improve circulation and nourish the nerves. This was accompanied by rehabilitation.              

Post-treatment:
After 14 days of treatment, the respiratory function has improved. The basal respiratory sound is stronger than before. Sat is 95-98%. Ms. Green can speak clearly and she doesn’t choke when she swallows food. The movement of the limbs has improved. The muscle strength of all four limbs has improved. The left arm can be lifted from the bed. The gripping strength of the hands has increased. The walking ability has also improved. She is able to walk independently for a short distance.