Yadivinder Narang-Amyotrophic Lateral Sclerosis-(America)

Name: Yadivinder Narang
Sex: Male
Nationality: American
Age: 61Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)
Discharge Date: 2019/05/08

Before treatment:
The patient had back pain in November 2018, left leg weakness in early January 2019 and weakness in the rest of the limbs two weeks later. He was diagnosed with amyotrophic lateral sclerosis at a local hospital and was treated twice a day with "riluzole" 50mg. It had no effect. Muscle tremors began to occur 2 months ago and limb weakness was aggravated. In the past month and a half he has relied on walkers for short distances. With sitting and standing he also needed to be supported by his arms. In the last week, the patient always had a sense of obstruction in the pharynx after taking medicine but his speech was still clear.
He has good spirit and sleep, his diet is normal. He uses medicines due to constipation every day and after taking medicine his stool is normal. Urination function is basically normal including one or two times at night.

Admission PE:
Bp: 123/82mmHg, Hr: 96/min, breathing rate 20/min. Body temperature: 36.4 degrees. The patient has good nutrition status and normal physical development. There was no injury or bleeding spots of his skin and mucosa, a dry but not congestive throat and normal tonsils. He has a symmetrical chest, reduced breathing activity, clear respiratory sounds bilaterally and no obvious dry or moist rales were heard. There was a regular heart rate and rhythm (96/m) with no obvious murmur heard, protuberant abdomen, no tenderness and masses, normal liver and spleen and no edema of the legs.

Nervous System Examination:
Patient was alert, had good spirit, clear speech, normal memory, calculation and orientation. Both pupils were equal in size with a diameter of 3 mm, reaction to light was sensitive and no nystagmus. Eyeballs can move freely. Symmetrical forehead wrinkle and nasolabial fold. Eyes can close forcefully, cheeks can bulge normally and the tongue can extend out in the middle with no muscle atrophy. There was flexible tongue movement, a weak soft palate bilaterally, the uvula leaned to the right, normal pharyngeal reflex, powerful neck-turning and a weak shrug on the left side. There was reduced muscle volume on the proximal sides of the 4 limbs, muscle atrophy in bilateral sternomastoid and Scapular muscle with mild muscle atrophy in bilateral arm muscles and greater thenars. Muscle power of the right arm was  level 4, right gripping power was level 3+. Muscle power of proximal side of the left arm was level 3, while that of the distal side was level 4-. Left gripping power was level 3. Muscle power of bilateral lower limbs was level 4-. Muscle tone of the 4 limbs was normal. The tendon reflex of both arms was reduced. Tendon reflex of both legs was normal. Bilateral palm-jaw reflex was negative. Right and left Hoffmann sign and Rossilimo sign were negative. Bilateral Babinski sign was negative. Bilateral deep and shallow sensation was normal by gross examination. Bilateral finger to nose movement was normal, right thumb to little finger cannot be finished and the left finger to finger movement can be done slowly. Bilateral fast alternate movement was a little clumsy. Bilateral heel-knee-tibia test was stable and accurate. 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 motor 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 the patient got improvement in the muscle power of his trunk and bilateral lower limbs of 10%. Muscle power of the bilateral lower limbs reached  level 4+. Movement endurance increased and his walking posture got better.

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