Mr. Migirov-Amyotrophic Lateral Sclerosis-(Russia)

Name: Mr. Migirov
Sex: Male
Nationality: Russian
Age: 60Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)
Discharge Date: 2018/04/14

Before treatment:
The patient had problems with walking 12 years ago and 3 years later the condition got worse. It was hard for him to walk, eat, dress, brush his teeth or wash his face. In recent years he felt weakness in his four limbs, he had muscle atrophy, swallowing problems, breathing problems, writing was hard and he had difficulty with drinking. He was diagnosed with motor neuron disease in 2009 and he has been to our hospital 6 times since then. At present he has problems with eating, drinking and breathing.
His spirit is bad, he has bad sleep and poor diet. He defecates once in about 4 days.

Admission PE:
Bp: 132/74mmHg, Hr: 88/min, breathing rate: 19/min, body temperature: 36.3 degrees. Blood oxygen concentration was 89-90%. The lungs breathing sounds were clear, there was abdominal breathing, there was no chest movement when he was breathing in a  lying position. He could breathe but with difficulty. There were no rales. The heart beat was powerful with regular cardiac rhythm and no murmur in the valve areas. The abdomen was soft, with no masses or tenderness. His liver and spleen were normal and there was edema in both legs.

Nervous System Examination:
Patient was alert, his mental status was weak, he had severe dysarthria, and slurred speech. He could not complete the examinations of memory, calculation and orientation ability. Both pupils were equal in size and round, diameter of 2.0 mm, react well to light, with no nystagmus and the eyeballs could move freely. The bilateral forehead wrinkle and nasolabial groove are symmetrical and he can close his eyes normally. His tongue can extend to the teeth and there is tongue muscle atrophy. Showing the teeth is normal but he cannot bulge his cheeks. The soft palate cannot lift powerfully, swallowing is  difficult and he had choking when he drinks water. There was obvious muscle atrophy of his bilateral erector spinae, supraspinatus, infraspinatus muscle, pectoralis major, intercostal muscles, arm muscle groups, thenar muscles, hands interosseous muscles and the leg muscle groups. The shoulder and elbow joints movement was limited, especially the right shoulder. The arms cannot stretch to a straight position, the left deltoid muscle power was 4- degrees, right side deltoid muscle power was 3+ degrees. The other arm muscles power was 4 degrees. The muscle power of the legs was 2+ degrees. He could not sit up, stand, walk or dress himself. He could only move a few small steps with walker support. The arm muscle power was normal, leg muscle power was increased, 4 limbs tendon reflex were active. Abdomen reflex was normal, bilateral palm-jaw reflex was positive, the Hoffmann sign, Rossilimo sign and Babinski signs were positive. His sensory gross examination was normal, finger to nose test and finger opposite movement were not stable and the fast alternate movement was clumsy. He could not perform the heel-knee-tibia test and the meningeal irritation sign was negative.

Treatment:
After the admission he received 4 times nerve regeneration treatment(neural stem cells and mesenchymal stem cells) to repair his damaged nerves, replace dead nerves, nourish nerves, regulate his immune system and improve blood circulation. This was done with rehabilitation training.     

Post-treatment:
After 20 days treatment his breathing function was much better, his lungs breathing sounds were much stronger and his blood oxygen concentration increased from 90 to 96%. His tongue muscle could move in a much more flexible manner and the choking symptoms reduced. He now spoke clearer. The muscle power of his arms  increased 20% and he could raise his arms higher. The fine motor movement of his hands improved and he walked better and faster.

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