Lucy-AmyotrophicLateral Sclerosis-(UK)

Name: Lucy
Nationality: UK
Age: 65Y
Diagnosis: 1. AmyotrophicLateral Sclerosis(ALS) 2. Hypertension                     
Discharge Date: 2018/12/11

Before treatment:
The patient felt pain in her right shoulder and she couldn’t move her right hand well 7 months ago. She then began to speak unclearly and  3-4 months ago it became hard for her to breathe at night and she was unable to lie down. One month ago she did an EMG and was diagnosed with ALS. Her condition got worse and worse, she choked when drinking, 3 weeks ago her language ability decreased 50% and she found it hard to walk and needed help. It was hard for her to move her right arm and she felt pain in her neck, back and shoulders. Sometimes she choked when she was drinking and she felt short of breath after exercise.
Her spirit is good, she turns over her body when she is sleeping every 1-2 hours because of pain, her diet, urination and defecation functions are normal. She has lost 10KGs in weight, she has had hypertension for many years and she takes medicine to control it.

Admission PE:
Bp: 123/79mmHg, Hr: 89/min, breathing rate: 28/min, body temperature: 36.2 degrees, weight 93Kg. The patient's nutrition status was good with normal physical development. There was no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion and her tonsils had not swollen. Chest development was normal, the respiratory sounds in the  lower lungs part were weak, there was no dry or moist rales. The heart beat was 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 with no edema of the legs.

Nervous System Examination:
Patient was alert, had a normal mental status and slurred speech (50% deficit). Her 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 and there was no nystagmus. Her eyeballs cannot look upward well, the side movement was normal. The bilateral forehead wrinkle and nasolabial fold were symmetrical, she could make her tongue extend out normally and there was mild tongue muscle atrophy. Showing the teeth was normal, she could bulge her cheeks, chewing ability was normal and the the soft palate could lift powerfully. She could close her eyes powerfully, her neck was soft and she could turn her neck. The shrug ability of the right side was worse than left side. The left arm proximal side muscle power was 4- degrees, distal side muscle power was 4 degrees. The left hand grip force was 4 degrees. The right arm proximal side muscle power was 2 degrees, distal side muscle power was 2+ degrees and the right hand grip force was 2 degrees. Muscle power of the legs was 3 degrees. The 4 limbs muscle tone were normal, the ankle clonus was negative, bilateral biceps reflex, radial periosteal reflex and triceps reflex were reduced. The patellar tendon reflex in the legs could not be induced, the palm-jaw reflex was negative, bilateral Hoffmann sign and Rossilimo sign were negative, the Babinski sign was a doubtful positive. She could not perform the right side finger to nose test, fast alternate movement or finger opposite movement because of weakness. The left side finger to nose test, fast alternate movement and finger opposite movement were normal. Heel-knee-tibia test were normal and the meningeal irritation sign was negative.

After the admission she received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged nerves, replace dead nerves, nourish nerves (ganglioside, nerve growth factors and neurotrophic factors), improve body environment (Edaravone and Riluzole ), regulate her immune system and improve blood circulation. This was combined with rehabilitation training.     

After 14 days treatment her condition got better, there was less pain in her body and  less fasciculation. She spoke  clearer and louder than before, she ate faster and had less choking. Her respiration function was better with the oxyhemoglobin saturation was 97-98%. The 4 limbs muscle power improved, the right forearm could lift much better and the right hand fingers can move with much more flexibility. Her right side body pain alleviated, right occipital area pain nearly disappeared, the left leg muscle power increased to 4 degrees and she was now able to walk better and for longer.

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