Lisa-AmyotrophicLateral Sclerosis-(UK)

Name: Lisa
Sex: Female
Nationality: UK
Age: 57Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)
Discharge Date: 2018/10/21

Before treatment:
The patient felt weak in her four limbs and this was accompanied by muscle atrophy 1 year ago. After that she also felt weakness in swallowing and she choked when drinking. She went to a local hospital and was diagnosed with ALS. Her condition still got worse and in recent months she was unable to stand up, sit up, walk, change her position and she needed help with daily life. She couldn’t speak clearly or chew powerfully so she ate slowly and ate semi liquid food and still choked a lot.
Her spirit is normal, she needs medicines for sleeping, has regular urination and defecation functions and has lost 5 KGs.

Admission PE:
Bp: 135/85mmHg, Hr: 79/min, breathing rate: 23/min, body temperature: 36.7 degrees. Nutrition status was good with normal physical development. There was no injury or bleeding spots of her skin and mucosa, no throat congestion, no tonsil swelling and her chest was symmetrical.
The respiratory sounds in both lungs were clear, but weak at the bottom, 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 with no masses or tenderness. The liver and spleen were normal. There was mild edema of her right dorsal foot, there was no edema of her right leg. Skin temperature was normal and the arterial pulse of her dorsal foot was good.

Nervous System Examination:
Patient was alert, in good spirit, had dysarthria and slurred speech. Her memory, calculation and orientation abilities were normal. Both pupils were equal in size and round, diameter of 3 mm, the reaction to light was sensitive, her eyeballs can move freely and there was no nystagmus. The bilateral forehead wrinkle and nasolabial fold were symmetrical and she could close her eyes powerfully. There was weakness in bulging her cheeks, her tongue was able to reach her lips, there was no fasciculation in her tongue but there was mild muscle atrophy and its movement was weak. The soft palate was weak in lifting bilaterally, she was weak to turn her neck and she could not shrug. The proximal muscle power of her right arm is grade 2-, the distal abductor and adductor power is grade 3- and 3 respectively. Her right gripping power is grade 3. The proximal muscle power of her left arm is grade 2, the distal abductor and adductor power is grade 3 and 3+ respectively, her left gripping power is grade 3+. The muscle power of her legs is grade 2-. The muscle tone of her left limbs is almost normal, the muscle tone of her right limbs was increased. There is mild muscle atrophy in her four limbs. Bilateral tendon reflex in the arms is a little active, bilateral knee tendon reflex is hyperactive. Bilateral Hoffmann sign and Rossilimo are negative. Bilateral Babinski sign is positive. Bilateral deep, shallow sensation is normal by gross examination. Bilateral finger to nose movement cannot be carried out due to muscle problems. Fast alternate movement is slow, finger to finger movement can be done and the bilateral heel-knee-tibia movement cannot be done. The meningeal irritation sign is negative.

Treatment:
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.    

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