Ms. Salmen-Motor Neuron Disease-(Pakistan)

Name: Ms. Salmen
Sex: Female
Nationality: Pakistani
Age: 38Y
Diagnosis: 1. MND 2. Post Gastrostomy

Before treatment:
3 years ago the patient had no obvious indication of speech lallation but the disease progressed gradually involving the chewing /swallowing function. In the local hospital she was diagnosed with "motor neuron disease" and she was given " Riluzole" but without any good effect. One year ago she received a gastrostomy to help her eating. Within one year her disease began to involve the limbs. 5 months ago she could stand and walk with help but now she has been unable to stand, walk, sit up or stand up. Only bilateral upper limbs can lift off the bed and she has difficult with breathing. The patient wants further treatment, so she came to our hospital.
Her spirit is good, she eats with gastrostomy, her urination function is good but she has constipation. She has lost almost 30 KGs.  

Admission PE:
Bp: 105/72mmHg, Hr: 106/min, breathing rate: 23/min, body temperature: 36.6 degrees. Nutrition status is not very good but there was 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 both lungs were clear with no dry or moist rales. The heart beat is strong with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft and flat with no masses or tenderness. There is a gastrostomy tube fistula in the middle of abdomen with mild excretion. The liver and spleen were normal, shifting dullness was negative, spinal column is normal with no edema in both legs.

Nervous System Examination:
Patient was alert and mental status was good but she cannot speak. The memory, orientation and calculation ability were normal. Both pupils were equal in size and round, diameter of 3.0mm, react well to light and the eyeballs can move freely. Bilateral forehead wrinkle and nasolabial groove is symmetrical, she had difficulty opening her mouth or putting the tongue out due to poor movement ability of the tongue. Showing of the teeth is normal. Her tongue cannot touch the cheek powerfully, she cannot chew food and cannot bulge the cheek. The bilateral soft palate can lift and she can close her eyes powerfully. The neck is soft but she cannot shrug powerfully. Muscle power of the right arm is 2- degrees, left arm is 3 degrees, the grip force of the right hand is 2 degrees, left hand is 1 degree. The muscle power of the legs is 1 degree. Patient had severe muscle atrophy of the shoulder girdle muscles, intercostal muscles and all 4 limbs. Muscle tone of the 4 limbs is decreased. The left side biceps reflex and radial periosteal reflex are normal, right side cannot be induced. Her legs patellar tendon reflex is reduced, bilateral Palm-jerk reflex is positive, Hoffmann sign of both sides are positive. Her Rossilimo sign on both sides is negative, bilateral Babinski sign is negative. She cannot perform the left side finger to nose test and fast alternate movement test and can only do the finger opposite movement with her index finger. She cannot perform the Heel-knee-tibia test and the Meningeal irritation sign is negative.

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

After 14 days treatment her speech was much clearer than before and we can distinguish the pronunciation much easier. Her swallowing function is better, she could breathe better and Sat was improved to 96-99%. The arm movement was much more flexible and powerful, her grip force of both hands increased with the right hand now 3 degrees and  left hand  3- degrees. Her hands could now do fine movement better. Her legs are flexible and the muscle power of the legs is improved, she is able to raise her legs from bed.

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