Kenneth P Howard-Amyotrophic Lateral Sclerosis-(USA)

Name: Kenneth P Howard
Sex: Male
Nationality: USA
Age: 46Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)
Discharge Date: 2019/07/21

Before treatment:
One year ago the patient had no obvious cause of weakness in the right arm. His writing, lifting and grasping function became worse so he went to the local hospital and was diagnosed with "amyotrophic lateral sclerosis". After that he took oral riluzole (50mg Q12h) and did Edaravone intravenous infusion (60mg qd,10 days / month). The disease progressed gradually, his whole body muscle tremor began to appear 9 months ago which was obvious during fatigue. Six months ago the patient began to show right arm and foot spasm, he had no pain but muscle tension when he did activities. He took oral baclofen but with no improvement. Weakness of the left arm, dysphagia and speech dysfunction occurred 3 months ago.    At present he can take care of himself, he can walk independently, he has dysfunction in the arms with the right arm heavier, his speech is unclear, swallowing is also involved with sticky food  more difficult to swallow. 
He has good spirit, good sleep, defecates once in three days and urinates regularly.

Admission PE:
Bp: 112/77mmHg, pulse rate: 78/min, breathing rate 18/min, body temperature: 36.6 degrees. The patient displayed unremarkable nutrition status with normal physical development. There was no ecchymosis of the skin or mucosa, no congestion of the throat, a symmetrical chest, clear respiratory sounds of both lungs with no dry or moist rales heard. He had regular heart sounds, regular heart rhythm, no obvious murmur heard in valves, a soft abdomen, no rebound tenderness, normal liver and spleen, no edema of bilateral limbs and with arteriopalmus felt.

Nervous System Examination:
The patient was alert, in good spirit, had slurring of his speech, normal memory,  calculation and orientation abilities. Both pupils were round and equal in size, with a diameter of 3 mm and reacting sensitively to light. There was free eyeball movement, no nystagmus, strong eye-closing and symmetrical forehead wrinkle and nasolabial fold. He displayed poor cheek puffing, the tongue was in the middle when extended and can reach beyond the lips, without muscle fibrillation. He has poor tongue muscle movement, can lift the soft palate and has strong neck-turning and shrug. Muscle power: proximal end of right arm 3; distal end of right arm 4-; proximal end of left arm 4-; distal end of left arm 4; right gripping power was 4-; left gripping power 3+. Muscle power of both legs was 4-. There was slightly higher muscle tone in the arms and obviously higher tone in the legs. There was active tendon reflexes of the 4 limbs and a positive bilateral ankle clonus. Positive bilateral Hoffmann sign, Rossilimo sign, and Babinski sign. Normal deep and shallow sensation bilaterally. Clumsy fast alternate movement bilaterally. Only 2 fingers can do finger to finger movement on the right side, while the little finger cannot do the finger to finger movement on the left side. Bilateral heel-knee-tibia test cannot be done and the meningeal irritation sign was negative.

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 tips blood oxygen saturation maintained around 97-98%), his respiratory function got better, movement endurance increased, bilateral leg muscle power increased 10% and muscle tone decreased remarkably. His walking posture got better, muscle strength of both arms was increased, he could now move his shoulder joints easier and his fingers were more flexible than before.

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