Mr. Ali-Amyotrophic Lateral Sclerosis-(Jordan)


Name: Mr. Ali
Sex: Male
Nationality: Jordanese
Age: 65Y
Diagnosis: Amyotrophic Lateral Sclerosis( ALS)     
Discharge Date: 2019/3/31

Before treatment:
Two and a half years ago the patient felt pain in his right leg, weakness combined with muscle tremor and his left leg was also affected. He then felt pain in both legs. He quickly went to the local hospital to see a doctor and was diagnosed with "amyotrophic lateral sclerosis" after various examinations. The doctor gave Riluzole to him but he stopped using it a month later because of abnormal liver function. After that his condition gradually progressed. He went to China for stem cell treatment two years ago but ended the treatment early and received anticoagulant therapy because of the occurrence of deep venous thrombosis of the left lower extremities. A year and a half ago his condition continued to decline and his four limbs were completely unable to move. He couldn’t take care of himself. 
He has poor mental condition, poor sleep, bad appetite, uses medicines for defecation and his urination function is normal.

Admission PE:
Bp: 136/96mmHg, Hr: 68/min, breathing rate: 22/min, body temperature: 36.0 degrees. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa and no blausucht. Chest development was normal, his chest movement range decreased when he was breathing, the respiratory sounds in lower lungs part 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, shifting dullness was negative, spinal column was normal and there was no edema of the legs.

Nervous System Examination:
Patient was alert with normal mental status, his speech was slightly affected. 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 make his tongue extend out normally, the tongue muscle can move freely, showing teeth was normal, he could bulge cheek powerfully, chewing ability was normal, the soft palate can lift normally and the uvula was turned to left side. There was muscle atrophy of the bilateral shoulder girdles, 4 limbs, thenar muscles and  hands interosseus muscles. His neck was soft, shrug and turning neck ability was weak. The arm proximal side muscle power was 1 degree, right distal side muscle power was 2 degrees, the left side distal muscle power was 1 degree. His leg muscle power was 1 degree. The hands finger joints were rigid, he could not grasp and can only can move his fingers slightly. The 4 limbs muscle tone were low, right elbow joint cannot bend well and the 4 limbs tendon reflex can not be induced. His bilateral Babinski sign and Hoffmann sign were negative, he can only perform the right hand finger opposite movement with one finger, left side cannot perform that movement at all. He could not perform the finger to nose test or fast alternate movement because of weakness. The heel-knee-tibia test cannot be performed, 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 14 days treatment his respiration function was improved, his fingertip oxygen saturation was 96-98%, he spoke better, louder and clearer. His swallowing function was better, he ate quickly and ate more food. The muscle power of his arms was increased, he could now move his hands and grasp better. Right hand grip force was around 3 degrees, left hand grip force was around 2 degrees. He could now move his fingers better. The muscle power in his legs was increased, he could move his legs easier and could now stand with help.



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