Miram-Amyotrophic Lateral Sclerosis-(Israel)

Name: Miram
Nationality: Israeli
Age: 44Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS) 2. hypokalemia
Discharge Date: 2018/01/02

Before treatment:
The patient felt weakness in the right side of her  body 2 years ago. This was accompanied by facsiculation, language and swallowing problems. She spoke slowly, felt short of breath after movement and coughed when she ate. She was diagnosed with ALS one year ago and her respiration became weak also. At present she is unable to walk, turn over or sit up by herself. She can’t speak clearly, she eats soft food and eats less than before. She coughs a lot when she drinks.
Her spirit is normal but she has less sleep due to pain in her legs and shortness of breath. She eats less than before. Her urination and defecation functions are normal.

Admission PE:
Bp: 121/77mmHg, Hr: 88/min, breathing rate: 24/min, body temperature: 36.7 degrees. Patient has normal physical development and nutrition status was fine, there is no injury or bleeding spots of her skin and mucosa, no congestion of the throat and no tonsil swelling. Chest development is normal, the lungs breathing sounds were clear but the lower lungs part were weak with no rales, The heart beat was powerful with regular cardiac rhythm and no murmur in the valve areas. The abdomen was soft and bulging with no masses or tenderness. Her liver and spleen were normal, shifting  dullness was negative and there was no edema of the legs

Nervous System Examination:
Patient was alert, had slurred speech and her mental status was fine. Her memory, calculation and orientation abilities are normal. Both pupils were equal in size and round, diameter of 3.0 mm and react well to light with no nystagmus. The bilateral forehead wrinkle and nasolabial groove are symmetrical. She can make her tongue extend out to the teeth on the side, there was tongue muscle atrophy, showing the teeth was normal but her tongue could not touch the cheek and she could not bulge her cheeks. The bilateral soft palate could not lift powerfully, she could close her eyes as normal, the neck was soft and she could not turn her neck or shrug powerfully. The left arm proximal side muscle power was 3- degrees, distal side muscle power was 3 degrees. Right arm proximal side muscle power was 3 degrees, distal side muscle power was 3+ degrees. Left hand grip force was 3 degrees, right hand grip force was 3+ degrees. Left leg muscle power was 2+ degrees, right leg muscle power was 3- degrees. Her 4 limbs muscle tone were basically normal and the ankle clonus was positive. Bilateral biceps reflex, triceps reflex, radial periosteal reflex and leg patellar tendon reflex were active. The Hoffmann sign of both sides were positive, bilateral Rossilimo sign were positive, the Babinski sign of both sides were positive. She could not perform the finger to nose test of the right side because of weakness, she only could do 2 fingers opposite movement, her left side finger to nose test and finger opposite movement were normal. Fast alternate movement was clumsy and she could not do the heel-knee-tibia test because of weakness. The meningeal irritation sign was negative.

After the admission she received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged nerves, replace dead nerves with new injected stem cells, nourish nerves, regulate her immune system and improve blood circulation. This was done with rehabilitation training.     

After 14 days treatment her respiration function became better, the blood oxygen concentration improved to 95-97%, her leg pain reduced and the muscle power of her arms was increased 20%. She could now raise  her arms  up higher and her exercise endurance was better. The muscle power of her legs was increased 20%, the muscle power of right leg was now 3+ and the left leg was 3. She could now walk 15 meters by herself. 

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