Colleen Joy Debenetti-Amyotrophic Lateral Sclerosis-(USA)

Name: Colleen Joy Debenetti
Sex: Female
Nationality: USA
Age: 57Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS) 
Discharge Date: 2019/09/16

Before treatment:
In June 2018 there was no obvious cause of pronunciation change and this condition gradually aggravated. The speech became more and more unclear with the dysarthria. The disease gradually progressed with a cough when drinking water and dysphagia. After examination in the local hospital it was diagnosed as "amyotrophic lateral sclerosis" in February 2019. Gastrostomy was done in March. In June, she could not eat through the mouth, she depended on total gastrointestinal nutrition and the situation of drooling has been aggravated in the last month. At present her language is bad, she can’t chew or swallow but she can drink a little water through the mouth. Her limb movement has not been significantly affected and she can take care of herself. When communicating with people she must rely on writing.
Her spirit is normal, she has lost some weight, has a PEG diet, poor sleep, urination function is normal and defecation is a soft stool once in three days.
Admission PE:
Bp: 140/76mmHg, heart rate: 82/min, body temperature: 36.6 degrees. There was no yellow stains or bleeding spots of the skin or mucosa, a symmetrical chest, clear respiratory sounds of both lungs, no dry or moist rales heard, regular heart rhythm and no obvious murmur heard in valves. She had a flat and soft abdomen, no tenderness or rebound tenderness, normal liver and spleen, no edema of the legs, poor muscle volume around both shoulders, arms and hands.

Nervous System Examination:
The patient was alert, in good spirit, has normal memory, calculation and orientation abilities. Both pupils were round and equal in size, with diameter of 3 mm and react sensitively to light.
There was free eyeball movement, strong eye-closing, symmetrical forehead wrinkle and nasolabial fold, inability to extend the tongue out (cannot reach the teeth), remarkable muscle atrophy and fasciculation of the tongue and difficulty to show the teeth. She was unable to puff her cheeks, had weak soft palate-lifting bilaterally, no gag reflex, a disabled chewing action, drooling, a weak cough, feeding by PEG tube, dysarthria, anepia, weak muscle power of the neck and unlimited head-lifting and neck-turning. There was grade 4  muscle power of both arms, grade 5 of muscle power of the legs, normal muscle tone of the 4 limbs, active biceps reflex bilaterally, normal radioperiosteal reflex, active knee tendon and heel tendon reflex bilaterally, normal abdominal reflex and a positive palm-jaw reflex. The Hoffmman sign and Babinski sign bilaterally were positive with normal deep and shallow sensation by gross examination, normal finger to nose, fast alternate, and heel-knee-tibia test and a negative meningeal irritation sign.
After the admission the patient received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged nerves, replace dead nerves, nourish nerves (ganglioside, nerve growth factors and neurotrophic factors), improve body environment,(Edaravone and Riluzole ) regulate her immune system and improve blood circulation. This was done along with rehabilitation training.   

After 14 days treatment her tongue movement, swallowing function, and enunciation got better than before. Her tongue could now reach her lips and reach the cheek on the right side but with left side worse than the right side. She could slowly take soft food such as noodles with the mouth, could pronounce sounds like “a, wu, one” and her articulation got clearer than before. She could eat soft food. The muscle power of the arms became 5- and she could now raise her arms higher and move fingers easier.

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