Mr. Philip-Amyotrophic Lateral Sclerosis-(Israel)

Name: Mr. Philip
Sex: Male
Nationality: Israeli
Age: 65Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS) 2. Arrhythmia (frequent superventricular premature)

Before treatment:
The patient felt weakness in his right arm 2 years ago. He also had muscle atrophy and was unable to raise  his right arm after a while so he went to a local hospital and did some tests. He didn’t get any diagnosis and then his left arm became weak 4 months ago so he went to the local hospital again and was diagnosed with ALS. He had headaches when he was walking and it was easy for him to be tired. His chewing function was bad, sometimes he felt short of breath and it was hard for him to cough or cough of phlegm. At present he is able to walk by himself, he needs help to turn over his body and sit up, he feels short of breath after moving and he needs help to eat and wash his hands.
His sleep, spirit and diet are normal. His urination function is normal but he needs help for defecation and has lost 10kg in 2 years. He has frequent superventricular tachycardia

Admission PE:
Bp: 130/82mmHg, Hr: 68/min, breathing rate: 19/min, body temperature: 36.7 degrees. The patient had normal physical development and nutrition status was fine. There was no injury or bleeding spots of his skin and mucosa, no congestion of throat and no tonsil swelling. Chest development was normal, the chest movement decreased when he was breathing. The breathing sounds of the lungs was clear while in the lower part it was weak and with no rales. The heart beat was powerful but with irregular cardiac rhythm and no murmur in the valve areas. The abdomen was soft and flat with no masses or tenderness. His liver and spleen were normal, shifting dullness was negative and no edema of the lower limbs.

Nervous System Examination:
Patient was alert, mental status was fine, speech was clear, memory, calculation and orientation abilities were normal. Both pupils were equal in size and round, diameter of 2.5 mm, react well to light, with no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial groove are symmetrical, he could extend the tongue out, there was no tongue muscle atrophy and showing the teeth was normal. The tongue could not touch the cheek powerfully, he could bulge the cheek but with air leakage, the bilateral soft palate could lift as normal and he could close his eyes powerfully. The neck was soft, he could not turn his neck or shrug powerfully. The left arm proximal side muscle power was 3- degrees,  distal side was 3 degrees. The right arm proximal side muscle power was 1 degree,  distal side was 2 degrees. The left hand grip force was 3+ degrees,  right hand grip force was 2 degrees. The leg muscle power was 5 degrees. The 4 limbs muscle tone was basically normal and ankle clonus was negative. The bilateral biceps reflex, radial periosteal reflex and triceps reflex cannot be induced. The leg patellar tendon reflex was normal,  Achilles tendon reflex cannot be induced by examination. The Hoffmann sign and Rossilimo sign of both sides were negative, bilateral Babinski sign were positive, he could not perform the finger to nose test because of weakness. He could perform the right side finger opposite movement with 2 fingers, left side finger opposite movement was normal, he could not perform the right arm fast alternate movement and the left side was clumsy. The heel-knee-tibia test was normal and the meningeal irritation sign was negative.

After the admission he received 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.     

After 14 days treatment his respiration function is better, blood oxygen concentration increased to 95-98%, his voice was louder, left arm movement ability showed positive change,  endurance improved and he could lift his arms much higher. Right hand fingers could move with much more flexibility., the heart rate was much more stable and he did not have frequent superventricular tachycardia.


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