Richard Curtis-Motor Neuron Disease-(UK)

Name: Richard Curtis
Sex: Male
Age: 49Y
Diagnosis: Motor Neuron Disease (MND)   
Discharge Date: 2019/4/1

Before treatment:
One and half years ago the patient's right calf muscle stiffened when he exercised, then weakness gradually appeared in the right lower extremity and the flexibility of the right foot decreased. 3 months later it developed in the left lower extremity so he went to the local hospital for treatment. After a series of examinations it was clearly diagnosed as "motor neuron disease" on August 3rd, 2011. Nine months ago he began to have muscle spasms and muscle tremor. The muscle spasm mostly occurred at night affecting his sleep so he took oral "quinine" to improve his sleep. His lower extremity muscle weakness and spasms caused progressive aggravation. He began to participate in the double-blind placebo trial (MIROCALS) 7 months ago. His upper arm was injected 5 times in the initial 5 days of each month. The trial was planned to last for 20 months. 7 trials had been completed and the condition had not improved. At present he needs a walker to help with walking for a short distance, he can not stand independently, his breathing, swallowing and speech function are not significantly affected.
His spirit, sleep and diet are normal. His urination and defecation functions are normal.

Admission PE:
Bp: 145/92mm Hg, Hr: 56/min, breathing rate 18/min, body temperature: 36 degrees. Height 178cm, weight 100Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion and his tonsils do not have swelling. Chest development was normal, the respiratory sounds in both lungs 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 bulging 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 clear speech and his mental status was fine. His memory, calculation and orientation abilities were normal. Both pupils were equal in size and round with a 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, he could close his eyes powerfully, could bulge his cheeks and make his tongue extend out normally. There was no tongue muscle tremor and the tongue muscle can move flexibly. The soft palate can lift normally, the uvula was in middle position and pharyngeal reflex existed. He could turn his neck and shrug powerfully. Muscle power of the arms was 5 degrees, grip force was 5 degrees, right leg muscle power was 2 degrees, left leg muscle power was 4- degrees. The 4 limbs muscle tone and tendon reflex was normal. Bilateral Palm-jaw reflex was negative, right side Hoffmann sign and Rossilimo sign were positive, left side Hoffmann sign and Rossilimo sign were negative. Babinski sign of both sides were negative. His sensory examination was normal by gross measure. Finger to nose test and finger opposite movement were normal. Right arm fast alternate movement was slightly clumsy, he could not perform the right side heel-knee-tibia test because of weakness, left side heel-knee-tibia test was not stable and 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 the muscle power of his trunk and limbs showed improvement of varying degrees. The muscle power of his right leg was now 3+ degrees, he could raise his right leg by himself and he can now go to bed without help. The movement endurance showed improvement in his left leg and both of his legs were more flexible. He could move faster and stand up by himself, could walk a short distance and it was easier for him to turn over his body.


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