Carmel-Amyotrophic Lateral Sclerosis-(Israel)

Name: Carmel
Sex: Female
Nationality: Israeli
Age: 46Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS)2. Post tracheotomy
Discharge Date: 2017/10/17

Before treatment:
The patient felt weakness  in her right leg 5 years ago, her other three limbs were are affected later and she was diagnosed with ALS by  a local hospital. She took Riluzole 50mg twice a day but 4 years ago she was unable to walk, 3 years ago she was unable to turn over and 2 years ago she was having swallowing problems.  She had to use PEG for food and also had a tracheotomy for a respiration machine. She had repeated pulmonary infections and at present she is paralyzed and uses a respiration machine.
Her spirit is normal, her sleep and diets are good. She has urinary incontinence and constipation.

Admission PE:
Bp: 114/78mmHg, Hr: 78/min, breathing rate: 19/min, body temperature: 36.2 degrees. There is a tracheotomy and a breathing tube in her neck as she uses a breathing machine. There are no other injury or bleeding spots of her skin and mucosa and no blausucht. The chest development is normal with her chest movement basically normal. Breathing sounds of both lungs were normal (with breathing machine support) and with no rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was bulging with no masses or tenderness. The liver and spleen were normal, shifting dullness is negative. The spinal column is normal and there was no edema of the legs.

Nervous System Examination:
Patient was alert and her mental status is good. Her 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 with no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical, she could not make her tongue extend out or show her teeth as normal. The tongue muscle could not move freely and it had mild atrophy. She could not chew powerfully and she could close her eyes powerfully. There was mild muscle atrophy of the bilateral shoulder girdle area, 4 limbs, thenar muscles and both hands interosseous muscles. Neck was soft, she could turn her neck to the right side about 30 degrees but she could not turn her neck to left side and she could not shrug. The muscle power of the 4 limbs was 0, muscle tone of 4 limbs was very low. The ankle clonus was negative, tendon reflex of the 4 limbs could not be induced, bilateral palm-jaw reflex was negative, Hoffmann sign of both sides were negative, bilateral Babinski sign was neutral. Patient could not perform the finger to nose test, fast alternate movement, finger opposite movement or heel-knee-tibia test because of weakness. The meningeal irritation sign is 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 his immune system and improve blood circulation. This was combined with rehabilitation training.     

After 14 days treatment her motor functions were better, she could move her tongue better, her chewing function was better, swallowing function was improved and she could eat semi-liquid food with her mouth. There was tendon reflex in her four limbs, the muscle power was increased 1-2 levels and her abdominal distension became better.


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