Mohammad Tahir Farooq-Amyotrophic Lateral Sclerosis-(Pakistan)

Name: Mohammad Tahir Farooq
Sex: Male
Nationality: Pakistani
Age: 44Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)
Discharge Date: 2019/04/23

Before treatment:
The patient felt pain in his left heel when he walked in January 2018. 2 months later it gradually developed to weakness of the left leg. 6 months ago he also had weakness in the right leg, obvious drop of the foot, difficulty in bending the back of the right foot and gradually he needed a walker to assist in walking. The condition continued to progress. After a series of examinations he was diagnosed with "amyotrophic lateral sclerosis." 4 months ago he began to do rehabilitation training, then 2-3 months ago he needed to be assisted to push the wheelchair or walker to walk slowly. In the recent two months he was completely unable to walk and the proximal end of the left arm was powerless. At present he cannot turn over, sit up or walk, and must rely on a wheelchair. He has normal diet and his sleeping is bad. 

Admission PE:
Bp: 143/101mmHg, Hr: 83/min, breathing rate 18/min. body temperature: 36.5 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, the respiratory sounds of both lungs part were clear 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 bulging and soft with no masses or tenderness. The liver and spleen were normal, spinal column was normal, shifting dullness was negative and there was no edema of the legs.

Nervous System Examination:
Patient was alert and his mental status was fine with clear speech. 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, the eyeballs can move freely and there was no nystagmus. The bilateral forehead wrinkle and nasolabial fold are symmetrical, showing teeth was normal, he could not make his tongue out normally, there was no tongue muscle atrophy and his tongue can move flexibly. He could bulge his cheeks and chew food normally. The soft palate can lift normally and the uvula was in middle. His neck was soft and he could turn his head flexibly. The distal side muscle volume of the legs was poor, he could not roll over in bed himself and he could not sit up or stand up without support. Right arm muscle power was basically normal, left arm proximal side muscle power was 5- degrees. The hands grip force was 5 degrees. The left leg muscle power was 1 degree and the right leg muscle power was 2 degrees. The 4 limbs muscle tone was normal. His left arm tendon reflex was normal, right arm tendon reflex was decreased, leg tendon reflex could not be induced. The ankle clonus was negative, Hoffmann sign of both sides was negative, bilateral palm-jaw reflex was positive and the Babinski sign of both sides are negative. His finger to nose test, fast alternate movement and finger opposite movement were normal. He could not perform the hell-knee-tibia test because of weakness. The meningeal irritation sign was negative.

Treatment:
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.    
  
Post-treatment:
After 14 days treatment his blood oxygen concentration improved to 96-98%, his movement endurance improved and the leg muscle power increased obviously. The right leg muscle power was now 2+ degrees, he could lift his leg up while in a sitting position. The left leg can perform the adduction and abduction movement slowly when he bends his hip and knee.

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