Mr. Harry-Amyotrophic Lateral Sclerosis-(Israel)

Name: Mr. Harry
Sex: Male
Nationality: Israeli
Age: 50Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS) 2. Hypertension

Before treatment:
The patient had muscle spasm in his legs 6 years ago and he was unable to walk well 4 years ago. He also had fasciculation in his left foot so he went to a  local hospital and did an EMG test and a gene test. He was diagnosed with ALS. His left leg became weak 3 years ago and the disease progressed fast with his right leg becoming weak too. He was unable to move his hands well 2 years ago, couldn’t control his neck 1 year ago and his voice was lower than normal. The muscle power of his back and waist was increased, he was unable to maintain a sitting position. At present, he is able to walk slowly for a short distance with aid, it is hard to him to change position, his voice is lower and his swallowing function is bad. Sometimes he will choke when he is drinking.
His spirit is good, he sleeps less, his defecation function is normal but sometimes he needs urgent urination, he has lost 18 kgs. He has had hypertension for many years.

Admission PE:
Bp: 118/84mmHg, Hr: 86/min, breathing rate: 19/min, body temperature: 36.2 degrees. Nutrition status is good with normal physical development. There was no injury or bleeding spots of the whole body skin and mucosa and no cyanosis. The chest development was normal, 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 and soft with no masses or tenderness. Liver and spleen were in a normal position by touch, spinal column was normal, shifting dullness was negative. He has used stretch socks for a long time so now there was no edema of lower limbs.

Nervous System Examination:
Patient was alert with clear speech. His voice was low, the memory, orientation and calculation abilities were normal . Both pupils were equal and round, diameter of 3.0 mm and react well to light. Both eyesight tests were normal with no nystagmus and the eyeballs can move freely. Bilateral forehead wrinkle and nasolabial fold are symmetrical, bilateral soft palate can lift as normal, the uvula was in middle, he can make his tongue extend out as normal and showing the teeth was normal. The patient can bulge his cheeks without air leakage. There was obvious muscle atrophy of the bilateral shoulder girdle area, the 4 limbs, thenar muscles and both hands interosseus muscles. The neck was soft, he could not turn his head or shrug well. The right arm proximal side muscle power was 3 degrees, left arm proximal side muscle power was 3+ degrees, the distal side of both arms muscle power was 4 degrees. The hands grip force was 4 degrees, right leg muscle power was 4- degrees, left leg muscle power was 2 degrees. Muscle tone of the four limbs were normal. The tendon reflex of the arms was basically normal, left leg tendon reflex was reduced whilst the right leg tendon reflex was normal. The Hoffmann sign, Rossilimo sign and Babinski sign were negative. The finger to nose test and fast alternate movements were normal. His little fingers had difficulty to perform the finger opposite movement whilst the others were normal. The left leg cannot perform the heel-knee-tibia test because of weakness. The meningeal irritation sign was negative.

Treatment:
After the admission he did related examinations and received 3 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.     

Post-treatment:
After 14 days treatment he spoke clearer and louder, his swallowing function was improved and there was no obvious choking when he ate. His arm muscle power increased 20%, the proximal muscle power of the left side was about level 4-，and the right arm was level 3+. The muscle power of both hands increased to about level 4+. His limbs were flexible, the muscle power of the left leg was increased 20%, his standing and walking postures are better and he could now walk longer distances.