Neo-Amyotrophic Lateral Sclerosis-(UK)

Name: Neo
Sex: Male
Nationality: UK
Age: 67Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)
Discharge Date: 2018/8/27

Before treatment:
The patient felt weak in his right arm 1 year ago and his left arm became the same soon afterwards. He was unable to raise his arms powerfully and he had fasciculation in his whole body. He did EMG and other tests and was diagnosed with ALS. He took Riluzole but his condition still got worse. His legs became weak and it was hard for him to walk. In recent months he spoke in an unclear way,  chewed slowly and sometimes he choked when he drank water. He needed help with his daily life.
His spirit, sleep, diet, urination and defecation functions are all normal. He has lost 15 Kgs.

Admission PE:
Bp: 137/85mmHg, Hr: 65/min, breathing rate: 18/min, body temperature: 36.4 degrees. Finger tips oxygen concentration was 91-93%. Height 173cm, weight 71Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion and his tonsils do not have swelling. Chest development was normal, the respiratory sounds in both lungs were clear whilst in the lower lungs part they 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 no edema of the legs.

Nervous System Examination:
Patient was alert and had clear speech with a low voice. His memory,  comprehension and calculation abilities were normal. Both pupils were equal in size and round, 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. He can close his eyes powerfully, extend his tongue out normally, there was no tongue muscle tremor, mild atrophy, the tongue muscle could move flexibly and the soft palate could not lift powerfully. He could turn his head and shrug powerfully. The right arm proximal side muscle power was 2 degrees, distal side abductor muscle power was 3- degrees, the adductor muscle power was 3 degrees and the  right hand grip force was 4 degrees. The left arm proximal side muscle power was 2- degrees, the distal side abductor muscle power was 3 degrees, adductor muscle power was 3 degrees and the left hand grip force was 4 degrees. The leg muscle power was 4 degrees and the 4 limbs muscle tone were basically normal. There was muscle atrophy of his shoulder girdle, supraspinatus muscles, infraspinatus muscle, deltoid muscles, intercostal muscles and the 4 limbs. His arm tendon reflex could not be induced, the leg patellar tendon reflex could not be induced and the Achilles tendon reflex was normal. Bilateral Hoffmann sign , Rossilimo sign of both sides  and the  Babinski sign were all negative. The patient's sensory examinations were normal, he could not perform the finger to nose test because of weakness, his fast alternate movement and finger opposite movement were stable and correct and the heel-knee-tibia tests were normal. 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 (neurotrophic factors and ganglioside), improve the internal environment (Edaravone) regulate his immune system and improve blood circulation. This was combined with rehabilitation training.     

After 14 days treatment his motor functions became better, he spoke better and clearer, he chewed better, he could raise arms easier, grasp better and move his joints easier. His arm proximal side muscle power was now 3 degrees, the distal muscle power was 4 degrees, the hands grip force  reached 5- degrees. His legs muscle power was 4+ degrees, he could walk longer and better, his endurance improved and the finger tips blood oxygen concentration was maintained at 95-99%.

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