Christopher Canepa-Amyotrophic Lateral Sclerosis-(USA)

Name: Christopher Canepa
Sex: Male
Nationality: USA
Age: 67Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)
Discharge Date: 2018/05/02

Before treatment:
The patient felt weak in his left leg in December 2016 and this was accompanied by fasciculation and muscle atrophy. His condition got worse and he was diagnosed with ALS. He took Riluzole 50mg, twice a day. He also did Edaravone 10 days per month for 3 months but his condition still got worse. At present he swallows slowly with just small pieces, it is hard for him to breathe in a lying position, he finds walking hard, he is unable to stand on one leg and his balance function is bad.
His spirit is normal, his appetite is not good, he sleeps well, his urination and defecation functions are normal , he has lost 18KG.

Admission PE:
Bp: 138/90mmHg, Hr: 62/min, breathing rate: 18/mim, body temperature: 36.3 degrees. Height: 185cm, weight: 84Kg. Blood oxygen concentration was 95%. Nutrition status is good with normal physical development. He was in a semi-reclining position with the bed angle around 30 degrees. There is no injury or bleeding spots of his skin and mucosa, no blausucht and no throat congestion. Chest development is normal, the chest movement reduced when he was breathing, the respiratory sounds in both lower lungs area were weaker than normal and there were no dry or moist rales. There was distant heart sounds with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft and flat with no masses or tenderness. The liver and spleen were normal, shifting dullness was negative, spinal column is normal and there is no edema in the legs.

Nervous System Examination:
Patient was alert and his mental status was fine with clear speech. 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 wrinkle and nasolabial groove is symmetrical, he can make his tongue extend out as normal, there is no obvious tongue muscle atrophy and his tongue can move freely. Showing teeth was normal, he could bulge his cheek normally and chewing ability was fine. His bilateral soft palate could lift as normal, the pharyngeal reflex was normal. His uvula was in middle position, his neck was soft and he could not turn his head or shrug powerfully. He could roll over in bed, stand or walk by himself. The arm proximal side abductor muscle power was 3 degrees, adductor muscle power was 3+ degrees. The right arm muscle power was weaker than the left side with the arms distal side and leg muscle power 4 degrees. His left ankle joints could not bend and his right ankle joint movement had some limitation. He could not walk straight and could stand with one leg for a short time. Using just the left leg standing was for 5 seconds, right side was 3 seconds. The 4 limbs muscle tone was normal, the arms tendon reflex could not be induced, the leg tendon reflex was reduced. The bilateral Hoffmann sign was negative, right side Rossilimo sign was positive. The bilateral Babinski sign was neutral. Patient could perform the finger to nose test, fast alternate movement and finger opposite movement normally. He could not maintain balance well when he was standing. The meningeal irritation sign is negative.

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

Post-treatment:
After 15 days treatment his breathing function improved and when he slept at night he could now do so lying on a bed with the angle less than 15 degrees. His chest movement range increased, his head and neck strength was stronger than before and the neck support time was longer than before. The distal side muscle power of the arms reached 4+ degrees with the proximal side muscle power  4 degrees and the leg muscle power was 4+ degrees. His endurance also improved.