Mohammad Altaf Husain-Amyotrophic Lateral Sclerosis-(Pakistan)

Name: Mohammad Altaf Husain
Sex: Male
Nationality: Pakistani
Age: 47Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)
Discharge Date: 2019/05/31

Before treatment:
There was no obvious cause of weakness of the right thumb and index finger in June 2017. Two months later it progressed to the right arm and then gradually to the left arm. The condition continued to progress and in the local hospital after a series of tests in September 2017 he was diagnosed with ALS and he began to take oral riluzole. Edaravone was used monthly for 14 days from October 2018 to March 2019 followed by daily administration of coenzyme Q10 but it failed to stop the development of the disease. At present the patient can turn over, sit up and walk on his own but his arm movement is partially restricted.
The patient has a good appetite, normal swallowing function, good sleep patterns and normal urination and defecation functions.

Admission PE:
Bp: 140/97mmHg, Hr: 90/min, breathing rate 19/min, body temperature: 36.4 degrees. The patient had good nutrition status, normal physical development, no lesion or bleeding spots across the skin or mucosa and no cyanosis around the lips. He had a symmetrical chest, clear respiratory sounds of both lungs bilaterally, no dry or moist rales heard, no bulge in the precordia, strong heart sounds, regular heart rhythm and no obvious murmur was heard in valves. He had a bulging abdomen wth no tenderness and masses, normal liver and spleen, negative shifting dullness, normal spinal column and no edema of the legs.

Nervous System Examination:
Patient was alert, in good spirit,  had normal articulation, clear speech, normal memory, orientation, and calculation abilities. Both pupils were round and equal in size, with a diameter of 3 mm, reacting sensitively to light. There was free eyeball movement, no nystagmus, symmetrical forehead wrinkle and nasolabial fold. The tongue was in the middle when extending out, without muscle atrophy, flexible tongue muscle movement and there was no deviation when showing the teeth. He had normal chewing, cheek-bulging and soft palate-lifting with the uvula in the middle. He had a soft neck, flexible neck-turning and a weak shrug. Muscle power: proximal side of left arm, 3+; right arm 2+; bilateral gripping power, 3; left leg 5; right leg 5-. There was normal tendon reflex and normal muscle tone of the 4 limbs and negative ankle clonus bilaterally. Negative Hoffmann sign bilaterally, positive palm-jaw reflex, positive Babinski sign bilaterally, clumsy finger to nose and fast alternate movement. Only the first three fingers of the left hand can do the finger to finger movement while the right hand cannot do that test at all. Normal heel-knee-tibia test, negative meningeal irritation sign.

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, cocktail drugs to improve body environment, regulate his immune system and improve blood circulation. This was combined with rehabilitation training.   

Post-treatment:
After 14 days treatment the patient’s blood oxygen saturation increased to 96%-98%, br was 19/min, hr was 78/min. His heart function was normal,  movement endurance increased slightly, he could raise his arms easier and shrug shoulders easier. The fingers of both hands are now more flexible, he could do the finger to finger test with almost every finger, the muscle strength of the right side increased to level 3+. The left arm can lift up higher than before and the muscle power was increased to 3+. The exercise tolerance of his legs was increased.

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