Hyder Abbood Mohsin Al-ibadi-Motor Neuron Disease-(Iraq)

Name: Hyder Abbood Mohsin Al-ibadi 
Sex: Male
Nationality: Iraq
Age: 53Y
Diagnosis: Motor Neuron Disease (MND)
Discharge Date: 2019/08/28

Before treatment:
One year ago there was no obvious cause of muscle tremor in the left arm and the tremor gradually aggravated. It then gradually developed in the right arm and both legs. With the aggravation of muscle tremor the left arm became weaker accompanied by muscle atrophy. After a series of examinations in the local hospital he was diagnosed with "motor neuron disease" 4 months ago. He took "riluzole" 50mg, twice a day and there was no significant effect. In the past 2 months the waist and abdomen muscle tremor began to occur affecting his sleep at night. Recently he has had occasional hiccups when eating and a cough when drinking water quickly. His chewing function is normal and there is no obvious dysphagia. He can take care of himself.  
His spirit is normal, he has poor sleep, normal diet, normal urination and defecation functions. He has lost 5 kgs in the past 1 year.

Admission PE:
Bp: 124/80mmHg, pulse rate: 69/min, breathing rate 19/min, body temperature: 37.1 degrees, height, 184cm; weight, 119kg. The patient has unremarkable nutrition with normal physical development. There was no ecchymosis of the skin or mucosa, no congestion of the throat, no swelling of tonsils, a symmetrical chest, no remarkable reduction of his breathing motion, clear respiratory sounds of both lungs and no dry or moist rale were heard. He has regular heart sounds, a regular heart rhythm with no obvious murmur heard in valves. With a bulging abdomen, no tenderness or rebound tenderness, no masses, normal liver and spleen, drumming sound heard by percussion, negative shifting dullness, normal bowel sound by stethoscopy and no edema of the legs.

Nervous System Examination:
Patient was alert, had good spirit, clear speech, normal memory, calculation and  orientation abilities.  Both pupils were round and equal in size, with a diameter of 3 mm, reacting sensitively to light, with free eyeball movement, no nystagmus and strong eyes-closing. He had a  symmetrical forehead wrinkle and nasolabial fold, normal cheek puffing, tongue in the middle when extended and free tongue movement without muscle atrophy. He displayed weak soft palate-lifting power, the uvula was in the middle, a normal pharyngeal reflex, strong shrug and neck-turning. There was a different level of muscle atrophy observed of the bilateral deltoid, scapular muscle, and left thenars. Muscle power: left arm proximal end, 3-; left arm distal end, 4-; left gripping power, 4; right arm proximal end 3; right arm distal end 4; right gripping power, 4; both arms 5-. There was normal muscle tone of the 4 limbs. There was no tendon reflex of both arms, reduced knee tendon reflex bilaterally and no heel reflex. Negative palm-jaw reflex, Hoffmann sign, Rossilimo sign, and Babinski sign bilaterally. Normal deep and superficial sensation by gross examination. Bilateral fast alternate test, finger to nose test and finger to finger test was basically finished. Stable and accurate heel-knee-tibia test. Negative meningeal irritation sign.

After the admission he received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged nerves, replace dead nerves, nourish nerves (ganglioside, nerve growth factors and neurotrophic factors), improve body environment, (Edaravone and Riluzole ) regulate his immune system and improve blood circulation. This was combined  with rehabilitation training.        

After 14 days treatment his blood oxygen saturation got better, his swallowing function was better with no more hiccups while eating or choking when drinking. There was a remarkable reduction of limbs’ fasciculation, slight reduction of abdominal fasciculation, both arms got stronger with the left arm now able to lift higher and the arm adductors got stronger. The muscle power of the legs was increased 5 levels, his joints were more flexible and he now walked better.

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