Ursel Gebhardt-Amyotrophic Lateral Sclerosis-(Germany)

Name: Ursel Gebhardt 
Sex: Female
Nationality: German
Age: 59Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)
Discharge Date: 2018/10/12

Before treatment:   
The patient felt weak in her left foot in 2014, it was hard for her to walk and her legs became weak gradually. 1 year later it became hard for her to write or raise her arms so she went to hospital in July 2016 and did some tests where she was diagnosed with ALS. She began to take Riluzole and did rehabilitation training. In November she was unable to walk and at present, she is lying on a bed all day and she needs help with meals, dressing, turning over and other things.
Her spirit, diet and sleep are normal. Her urination and defecation functions are normal. 

Admission PE:
Bp: 114/78mmHg, Hr: 103/min, breathing rate: 25/min, body temperature: 36.9 degrees. Nutrition status is good with normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion and her tonsils do not have swelling. Chest development was normal but her chest movement range decreased when she was breathing. The respiratory sounds in the lower lungs part were weak, there was no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was bulging and soft with no masses or tenderness. The liver and spleen were normal and there was mild edema of the legs.

Nervous System Examination:
Patient was alert, had a weak mental status but clear speech. Her memory,  comprehension and calculation abilities were normal. Both pupils were equal in size and round with a diameter of 3 mm, the reaction to light was sensitive, there was no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical, she can close her eyes powerfully, make her tongue extend out normally, there was no tongue muscle tremor or atrophy and the tongue muscle could move in a flexible manner. Showing the teeth was normal, she could bulge her cheeks but with air leakage and the  chewing ability was normal. The soft palate could lift powerfully. There was mild muscle atrophy of her shoulder girdle muscle groups, triceps muscles, biceps muscles, intercostal muscles, latissimus dorsi, quadriceps femoris and gastrocnemius muscle. Her neck was soft, she could turn her head but with less power and the  shrug ability was reduced. The muscle power of the arms was 1 degree, hands grip force was 2- degrees, the thumbs were straight while the other fingers were bent and could not stretch straight. Her leg muscle power was 1+ degree, the 4 limbs muscle tone was normal, the ankle clonus was negative. Bilateral biceps reflex and radial periosteal reflex were decreased, the leg patellar tendon reflex and Achilles tendon reflex exist, the bilateral Palm-jaw reflex was positive, the Hoffmann sign and Rossilimo sign of both sides were negative and the Babinski sign of both sides were negative. The patient could not perform the finger to nose test, finger opposite movement or fast alternate movement because of weakness. She could not perform the heel-knee-tibia test also because of the low muscle power. The meningeal irritation sign was negative.

Treatment:
After the admission she received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged nerves, improve body environment (edaravone) replace dead nerves, nourish nerves (Gangliosides and neurotrophic factors), regulate her immune system and improve blood circulation. This was combined with rehabilitation training.     

Post-treatment:
After 14 days treatment her motor function in the body became better, she could now raise her arms higher and her limbs became more flexible. Her arm muscle power reached 2+ degrees, hands grip force increased to 2 degrees and the leg muscle power was 2+ degrees. Her breathing function improved, Br: 20/min, the lower lungs area breathing sounds were much clearer and her blood oxygen concentration was now 96-98%.

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