Anita Kuba-Amyotrophic Lateral Sclerosis-(India)

Name: Anita Kuba 
Sex: Female
Nationality: Indian
Age: 59Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)
Discharge Date: 2018/06/13

Before treatment:
The patient felt weakness in her left hand fingers in 2015 and after that her condition got worse. Her four limbs all became weak and she was diagnosed with ALS in 2016. She began to take Riluzole and do rehabilitation training but in 2017 she was paralyzed and unable to take care of herself. She began to have Edaravone treatment for 6 months and her disease progression slowed but 3 months ago it got worse rapidly. She was unable to speak clearly or powerfully and it was hard for her to eat and breathe.
Her spirit is good, she needs help to turn over her body every 3 hours at night, she eats a liquid diet, her urination and defecation functions are normal.

Admission PE:
Bp: 134/83mmHg, Hr: 98/min, breathing rate: 28/min, body temperature: 36.9 degrees. Nutrition status was moderate with normal physical development. There was no injury or bleeding spots of her skin and mucosa, no blausucht, no oropharynx congestion and no tonsil swelling. The thoracic cage was symmetrical, the respiratory sounds in both lungs were rough and there was no obvious moist rales but dry rales could be heard occasionally. There was no bulge in her praecordia. The heart beat was passable with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was distended with no masses or tenderness. The liver and spleen were normal, the shifting dullness was negative. Physiological spinal curvature existed and there was mild edema of the legs.

Nervous System Examination:
Patient was alert but with weak spirit and her speech was slurred. Her memory, orientation and calculation abilities were normal. Both pupils were equal in size and round, diameter of 3 mm, reacted well to light and the eyeballs can move freely. There was no nystagmus. Bilateral forehead wrinkle and nasolabial fold were symmetrical. Her tongue tilted to the left slightly when she extended it out. There was muscle atrophy in her tongue, especially on the right side. Showing the teeth was normal but her tongue could not touch her cheeks. There was air leakage when she bulged her cheeks. Her chewing was weak but the bilateral soft palate can lift powerfully. She can close her eyes powerfully. There was obvious atrophy in her scapula muscle, triceps brachii muscle, biceps brachii muscle, intercostal muscles, latissimus dorsi muscle, quadriceps femoris muscle, biceps femoris muscle and gastrocnemius. Her neck was soft, she was weak in both turning her neck and shrugging. Bilateral  muscle power of the arms was grade 1+. Bilateral gripping power was grade 2-. Her fingers could not stretch out. Bilateral  muscle power of the legs was grade 1. Bilateral muscle tone of the arms was normal and of the legs it was higher. The ankle clonus was negative. Bilateral biceps femoris reflex and radioperiosteal reflex were active relatively. Bilateral knee tendon reflex and heel tendon reflex were active. Bilateral palm-jaw reflex, Hoffmann sign, Rossilimo sign, and Babinski sign were all positive. She could not do the finger to nose, fast alternating and heel-knee-shin movement due to muscle problems. The meningeal irritation sign was negative.

After the admission she received 3 nerve regeneration(neural stem cells and mesenchymal stem cells) treatments to active stem cells, repair her damaged nerves, replace dead nerves, nourish nerves, regulate her immune system and improve blood circulation. This was done with rehabilitation training.     

After 15 days treatment the proximal adducting muscle power of her arms has reached grade 3, distal muscle power reached  grade 2. Her gripping power reached  grade 2. Her speech was much clearer and fluent with enhanced endurance. Her breathing function showed improvement and her respiratory sounds in both lungs were clearer than before. She could speak louder and clearer. Her blood oxygen was maintained within the 93-97% range.

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