Mr.Fahad-Amyotrophic Lateral Sclerosis-(Saudi Arabia)
Name: Mr.Fahad
Sex: Male
Nationality: Saudi Arabian
Age: 54Y
Diagnosis: 1.Amyotrophic Lateral Sclerosis(ALS)2. Hypertension 1 degree
Discharge Date: 2018/07/29
Before treatment:
The patient felt weak in his legs two and half years ago. The left side was worse and after that his arms became weak too. He found walking hard 1 year ago and was diagnosed with ALS at a local hospital. He took Riluzole 50mg twice a day but his condition was not improved and then he felt difficulty in breathing 6 months ago. At present he is unable to sit up by himself, his balance function is bad, he can walk around 200-300 meters with an aid but he is unable to take care of himself.
His spirit, sleep, urination and defecation functions are all normal.
Admission PE:
Bp: 124/83mmHg, Hr: 68/min, breathing rate 20/min. Body temperature was 36 degrees and his finger tip blood oxygen concentration was 91-93%. He had normal physical development and good nutrition. There is no injury or bleeding spots of his skin and mucosa, no blausucht and no tonsil swelling. Chest development is normal, chest movement range decreased when he was breathing, the respiratory sounds in both lungs were clear and there were no dry or moist 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. His liver and spleen were normal by touch examination and there was no edema of the legs.
Nervous System Examination:
Patient was alert with clear speech while he felt his voice had become lower than before. 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, eyeballs can move freely and with no nystagmus. Bilateral forehead wrinkle is symmetrical, he could bulge his cheeks normally, tongue is in middle position with no tongue muscle tremor or muscle atrophy and he could close his eyes powerfully. His soft palate can lift powerfully, uvula was normal and pharyngeal reflex was normal. The power to turn his neck was normal and the ability to shrug was weak. His left shoulder joint movement was limited with pain, the left arm muscle power was 3 degrees, he had difficulty to lift the wrist and the left hand grip force was 3 degrees. The right arm muscle power was 4 degrees, right hand grip force was 4 degrees. The leg muscle power was 3- degrees, he can lift the left leg with muscle power of 3 degrees and the right side was 3+ degrees. There was muscle atrophy of his bilateral shoulder girdles, biceps muscle, triceps muscles, the finger interphalangeal muscles. The 4 limbs muscle tone were basically normal. Tendon reflex of the arms was normal, the legs tendon reflex was active, the ankle clonus was negative and the abdomen reflex could not be induced. The bilateral palm-jaw reflex, sucking reflex, Hoffmann sign of both sides and bilateral Rossilimo sign were all positive. The Babinski sign of both sides were a doubtful positive, his sensory system was normal by gross measure and the finger to nose test and fast alternate movement were not very stable because of weakness. The finger opposite movement was not stable or accurate and little finger could not perform that test. The heel-knee-tibia test was slow because of weakness and the Meningeal irritation sign was negative.
Treatment:
After the admission he received 3 nerve regeneration treatments (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 combined with rehabilitation training.
Post-treatment:
After 14 days treatment his hands grip force increased, his left arm muscle power increased to 3+ degrees and he could raise his arm easier. His leg muscle power reached 3+ degrees, he could walk in a much more stable way and for longer with a walker. His breathing function was better, the blood oxygen concentration was maintained at 95-96%.
