Brian Fuggle-Amyotrophic Lateral Sclerosis-(America)

Name: Brian Fuggle
Sex: Male
Nationality: American
Age: 56Y
Diagnosis: Amyotrophic Lateral Sclerosis ( ALS)  
Discharge Date: 2019/01/20

Before treatment:
A year ago there was no obvious inducement for the patient to salivate, his speech was unclear and the disease developed gradually. 10 months ago swallowing dysfunction occurred and sometimes he choked so he went to the local hospital and was diagnosed with "amyotrophic lateral sclerosis." "Riluzole" 50mg was given orally twice a day six months ago. The patient's condition progressed and gradually involved the extremities and the strength of the limbs weakened 2 months ago, especially in the right arm and the left leg.  At present the patient's speech is unclear with only a very small part of pronunciation that can be distinguished. He has swallowing dysfunction eating small blocks of food but with choking and his respiratory function is significantly weakened. His limb strength is declined but he can stand and walk independently but his gait is unstable and he fatigues easy. The walking distance is not more than 50 meters.
His spirit is OK, he eat less than before, sleeps well, defecates once every two days, occasionally has constipation and his weight loss is about 10kg.

Admission PE:
Bp: 116/84mmHg, Hr: 95/min, breathing rate: 19/min, body temperature: 36. degrees. Height 180.5cm, weight 64Kg. The patient  was thin with poor nutrition status and normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion and  there was too much oral secretion. Chest development was normal, his chest movement range decreased when he was breathing, the respiratory sounds in the lower lungs part were clear and 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 flat 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, had normal mental status, slurred speech and only  part of his pronunciation can be heard clearly. 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 with no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical, the soft palate could not lift powerfully, the uvula was in middle, he could make his tongue extend out to the lip on the side, there was tongue muscle atrophy and the tongue muscle could not move flexibly. Showing teeth was normal, he had difficulty to bulge his cheeks and the chewing ability was decreased. There was muscle atrophy of his shoulder girdle, arms, thenar muscles and intercostal muscles. His neck was soft and he could turn his neck or shrug. The right arm proximal side muscle power was 3 degrees and the distal side muscle power was 4 degrees. The left arm proximal side muscle power was 4 degrees and the distal side muscle power was 5- degrees. The right hand grip force was 5 degrees, the left hand grip force was 4 degrees, his leg muscle power was 4 degrees and the 4 limbs muscle tone were normal. The tendon reflex of the arms was normal, legs tendon reflex was decreased. The bilateral Hoffmann sign was negative, Rossilimo sign was negative, the Babinski sign of both sides was positive. The finger to nose test, fast alternate movement and finger opposite movement were normal. 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, 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.   

Post-treatment:
After 14 days treatment he spoke better and clearer, his swallowing function was improved, his drooling reduced, he could make his tongue extend out much better to around 2cm from the lips and he now ate faster. The arm muscle power increased, he could grasp with more power, his fingers were more flexible, the muscle power of his legs was increased, his exercise tolerance was increased and he now walked with more stability and for longer.   

 

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