Morchai-Amyotrophic Lateral Sclerosis-(Israel)

Name: Morchai
Sex: Male
Nationality: Israeli
Age: 55Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)
Discharge Date: 2018/05/15

Before treatment:
The patient’s left leg became weak 4 years ago and after that his other three limbs also became weak. He was diagnosed with ALS 3 years ago and he took Riluzole 50mg twice a day but his condition was not controlled. He did multiple stem cell treatments in other hospitals without any good effect. He was unable to walk, spoke unclearly and swallowed slowly. He began to use BiPAP 1 year ago and 9 months ago he began to eat a liquid diet. He did two weeks treatment in our hospital 8 months ago and his condition was better for 4 months, but 4 months later he choked when he ate. He did an emergency tracheostomy, used an invasive ventilator and also did PEG. At present the muscle power of his four limbs is decreased, he is unable to eat or dress himself, he is unable to sit up, stand up or walk and he speaks unclearly.
His spirit is normal, he sleeps well, his urination and defecation functions are normal. He has lost 11-13 kgs and he has had hypertension for many years.

Admission PE:
Bp: 138/112mmHg, Hr: 85/min, breathing rate: 20/min, body temperature: 36.5 degrees. The patient sits  in wheelchair, has had a tracheotomy, uses a breathing machine, P-A/C model, Pinsp 16mbar, PEEP 4mbar, Rate 14bpm, Tinsp 1.8s, Press Trig 2.0mbar, PEG tube (4 months). He has good nutrition status, there was no other injury or bleeding spots of his skin and mucosa and no tonsil swelling. His chest development was good but the chest movement range decreased when he was breathing. The respiratory sounds in both lungs were rough with 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,  shifting dullness was negative, spinal column was normal and there was no edema of the legs

Nervous System Examination:
Patient was alert and his mental status was good, he had dysarthria, slurred speech and his memory, orientation and calculation abilities were normal . Both pupils were equal in size and round, diameter of 3.0 mm, react well to light, eyeballs can move freely and there was no nystagmus. Bilateral forehead wrinkle is symmetrical, he could not make his tongue extend out to the lip on the side, there was tongue muscle atrophy and showing the teeth was normal. He could bulge the cheek with air leakage, chewing ability was weak and the soft palate could not lift powerfully. There was muscle atrophy in both shoulder girdles, arms, thenar muscles, and hands interosseous muscles. His neck was soft and he could not shrug his shoulders powerfully. Muscle power of the arms proximal side was 0 degrees, of distal side was 1 degree. The wrists could move and the fingers on both hands could move lightly but he could not grasp or perform the finger opposite test. Muscle power of the legs proximal side was 0, his right foot can bend slightly, muscle tone of the arms was normal and in the legs were increased. Bilateral biceps reflex and radial periosteal reflex could not be induced by examination. Both legs patellar tendon reflex and tendon reflex could not be induced. The bilateral Palm-jaw reflex were positive, Hoffmann sign of both sides were negative, both sides Babinski sign were negative. Patient could not perform the finger to nose test, fast alternate movement or finger opposite movement because of weakness. The heel-knee-tibia test could not be done and the meningeal irritation sign was negative.

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

Post-treatment:
After 14 days treatment the patient’s motor function was better and he spoke louder. His neck power increased, the muscle power of his arms was increased 1 level, his right wrist and fingers movement ability increased and his leg muscle strength increased. His ankles were more flexible and his feet could do the dorsiflexion and planter flexion better.