Ioannis Veis-Amyotrophic Lateral Sclerosis-(Greece)

Name: Ioannis Veis
Sex: Male
Nationality: Greece
Age: 31Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)
Discharge Date: 2019/10/13

Before treatment:
The patient suffered a fracture of his legs caused by a car accident three years ago. After the fracture healed he developed weakness of both legs followed by weakness of both arms. This was accompanied by tremors of muscle in both arms so he went to the local hospital. After various examinations it was clearly diagnosed as "amyotrophic lateral sclerosis". He used "riluzole" as treatment but with no obvious effect and he showed signs of nausea, poor appetite and other adverse reactions so he stopped taking the medicine. His condition continued to develop and he was unable to walk 10 months ago. He began to have unclear speech and occasional choking when drinking water 4 months ago. At present he cannot take care of himself, can only rely on the strength of the legs to complete a turn, cannot sit up, stand or walk alone and he cannot independently eat, wash and so on.
His mental mood is poor, with anxiety, his sleep depends on drugs, his diet, urination and defecation functions are basically normal. Weight loss is about 5Kg. 

Admission PE:
Bp: 132/102mmHg, pulse rate: 96/min, breathing rate: 22/min, body temperature: 36.7 degrees, weight: 70kg. The patient had normal physical development, good nutrition, no cyanosis of the lips, a symmetrical chest,   with severely reduced chest mobility. He had reduced respiratory sounds of both lower lungs, no dry or moist rales heard, no bulging of the precordia, strong heart sounds, regular heart rhythm and no obvious murmur heard in the valves. With a flat abdomen, no tenderness or rebound tenderness, no masses, normal liver and spleen, negative shifting dullness, normal spinal column, no edema of either leg and normal dorsal artery pulsation of feet.

Nervous System Examination:
Patient was alert, in good spirit, had slurring of speech, normal memory,  calculation and orientation abilities. Both pupils were round and equal in size, with diameter of 3 mm, reacting sensitively to light with free eyeball movement and without nystagmus. He had a symmetrical forehead wrinkle and nasolabial fold, his tongue was in the middle when extended, there is muscle atrophy and fasciculation of the tongue, limited tongue movement, no cheeks-puffing, normal chewing, weak soft palate-lifting bilaterally and the uvula is in middle . He had a soft neck, normal neck-turning and a weak shrug. With grade 2 muscle power of both arms, grade 2 right gripping power and disabled dorsal foot flexion bilaterally. There was  normal muscle tone of both arms, high  power, grade 2+ left gripping power, grade 3- muscle power of both legs, normal muscle tone of the legs, muscle atrophy observed of bilateral supraspinatus, infraspinatus, deltoid, 4 limbs, major and minor thenars and interosseus, normal sensation of his 4 limbs. There was  no tendon reflex of the arms, hyperactive tendon reflex of both legs, positive ankle clonus, positive Hoffmann sign and Rossolino sign bilaterally, positive Babinski sign bilaterally, bilaterally finger to nose movement was disabled, bilateral finger to finger movement disabled, clumsy fast alternate movement, bilateral heel-knee-tibia test disabled and a 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, Edaravone and neurotrophic factors) to improve body environment, regulate his immune system and improve blood circulation. This was done with rehabilitation training.   

After 14 days treatment his respiration function got better, oxyhemoglobin saturation was around 96-99%, his speech and swallowing function got better, he spoke clearer and there is no choking now when he drinks. His 4 limbs muscle power got 20% stronger than before, he could raise his arms easier, move shoulders better and grasp with more power. The muscle power of his legs increased 20%  reaching grade 4, the muscle tension decreased and the leg cramps reduced. He could now move faster and walk better.

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