Mr.Muhammad-Amyotrophic Lateral Sclerosis-(Pakistan)

Name: Mr.Muhammad
Sex: Male
Nationality: Pakistani
Age: 62Y
Diagnosis:  Amyotrophic Lateral Sclerosis(ALS)

Before treatment:
The patient was unable to move his tongue well 1 year ago and he was taken to the hospital but was not diagnosed. 2-3 months later he could not speak clearly and had some difficulty swallowing food so he was taken to the hospital again. He did an EMG and the result was normal. 3 months later his condition got worse, his right limbs were weak and he was diagnosed with ALS. There was no way to treat him at the local hospital and his motor functions, speaking ability and swallowing function became worse. 3 months before he took Riluzole 50mg twice a day, but there was no improvement. At present his speech is unclear, it is hard for him to swallow, he can’t move his four limbs well, especially the right side.
His spirit, sleep and diet are good, his urination and defecation functions are normal.

Admission PE:
Bp: 126/73mmHg, Hr: 68/min, breathing rate: 18/min, body temperature: 36.3 degrees. He had normal physical development and his nutrition status was good. There is no injury or bleeding spots of his skin and mucosa, chest development was good. When he was deep breathing the chest movement was weaker than normal. The respiratory sounds in both lungs were clear and there was no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was mildly bulging and soft, there was no mass that could be felt and no tenderness.  The liver and spleen were normal. No edema in the legs.

Nervous System Examination:
Patient was alert but his mental status was weak. He had slurred speech but the memory,  orientation and calculation abilities were normal . Both pupils were equal in size and round, diameter of 3.0 mm, react well to light and the eyeballs can move freely. Bilateral forehead wrinkles are symmetrical, he can make his tongue extend out, there was tongue muscle atrophy and his tongue could not move well. Showing the teeth was normal, he could not bulge the cheek, the chewing ability was weak. The bilateral soft palate could not lift as normal. The uvula was in middle and the pharyngeal reflex was weak. Neck was soft, he could turn neck with flexiblity while the power was weak, shrug ability was weak. The shoulder joints, elbow joints and metacarpophalangeal joints had movement limitation. The right arm proximal side muscle power was 1 degree, distal side muscle power was 3- degrees. The right hand grip force was 2 degrees. The left arm proximal side muscle power was 3- degrees, distal side muscle power was 3+, left hand grip force was 3 degrees. Right leg muscle power was 3-, left leg muscle power was 4- degrees. All 4 limbs muscle tone were normal. The tendon reflex of the arms was slightly active and of the legs normal. There was average muscle atrophy, bilateral Hoffmann sign was negative, Babinski sign was positive. He could not perform the finger to nose test, the fast alternate movement was slow, he could only do the finger opposite movement with his thumb, while he could perform the finger opposite movement with right hand fingers except with the little finger. The Heel-knee-tibia test was slow, the meningeal irritation sign was negative.

After the admission, he received related examinations and was diagnosed with Amyotrophic Lateral Sclerosis 2. Hypertension 3. Type 2 diabetes 4. CHD. He received3 times nerve regeneration treatment to repair his damaged nerves, replace dead nerves, nourish nerves, regulate his immune system and improve blood circulation. This was done  with rehabilitation training.     

After 14 days treatment the patient's breathing ability and heart function was stable, blood oxygen was 94-97% and the body support was more stable in the sitting position. The muscle strength of the four limbs were increased. The right hand grip power increased to level 3-, the left grip power of hand was increased to level 4-.The salivation was decreased.

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