Ken-AmyotrophicLateral Sclerosis-(India)

Name: Ken
Sex: Male
Nationality: Indian
Age: 66Y
Diagnosis: 1. AmyotrophicLateral Sclerosis(ALS) 2. Hypertension     
Discharge Date: 2018/11/20

Before treatment:
The patient felt weak in the right side of his body on Jan 17th 2018. He also felt pain in his body so he went to a local hospital and did an MRI without any abnormal results. His weakness became worse and 1 week later he also had fasciculation accompanied by mild muscle atrophy. Soon afterwards he had respiration problems in a lying position and he couldn’t speak clearly so he began to use a non-invasive ventilator for breathing. 7 months ago he did an EMG test and was diagnosed with ALS. He began to take Riluzole 50mg in a bid to control his disease but his condition continued to get worse. 4 months ago his legs became worse and he walked slowly so he did mesenchymal stem cells treatment 3 times but to no good effect. At present he needs help with his daily life, is unable to speak clearly, chews food in a powerless manner and eats slowly. It is easy for him to choke when drinking and eating and he needs a breathing machine when  in a lying position.
His spirit is normal, he urinates twice per hour with each time discharging about 50ml. He has lost 10 KGs in weight and he has had hypertension for many years.

Admission PE:
Bp: 160/100mmHg, Hr: 106/min, breathing rate: 25/min, body temperature: 36.7 degrees. The patient's weight is around 62Kg, with poor nutrition status but normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion and his tonsils did not have swelling. Chest development was normal, chest movement range was decreased when he was breathing, the respiratory sounds in the lungs were weak and there were 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 and slurred 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, no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical, he can close his eyes powerfully, could not bulge his cheeks powerfully, can make his tongue extend out to the lips on the side, there is no tongue muscle tremor and with mild muscle atrophy. The tongue cannot move freely, his tongue could not push against his cheek powerfully, the bilateral soft palate could not lift powerfully, his neck could not turn powerfully and he could not shrug. The right arm proximal muscle power was 0 degrees, the distal side abductor muscle power was 1 degree, adductor muscle power was 1+ degree and the right hand grip force was 2- degrees. His left arm proximal side muscle power was 1 degree, the distal side abductor muscle power was 3 degrees, adductor muscle power was 3 degrees and the left hand grip force was 3+ degrees. His leg muscle power was 3+ degrees and muscle tone was normal. There was muscle atrophy of his shoulder girdles muscle group, supraspinatus, infraspinatus, bilateral intercostal muscles, limbs girdles, thenar muscles, hands interphalic muscles, etc. The tendon reflex of the arms disappeared,  patellar tendon reflex of the legs could not be induced, bilateral Hoffmann sign, Rossilimo sign  and the Babinski sign of both sides were all negative. The sensory system examination was normal by gross measure. He could not perform the finger to nose test and fast alternate movement because of weakness. Patient could perform the finger opposite movement slowly. 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 (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.       

After 10 days treatment the patient spoke better and clearer, his respiration function was improved, the oxyhemoglobin saturation was 96-98%. The muscle power of his arms was increased, the proximal muscle strength of left arm was level 2, right arm was level 1. The distal muscle strength of the left arm was level 3+, right arm was level 1+, the grip of the left hand was level 4 and the right hand was level 2. His hands could now do fine movement better. The muscle power of his legs was now level 4, he could raise his legs easier and walk longer.

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