Mudasar Zulfiqar-Amyotrophic Lateral Sclerosis-(Denmark)

Name: Mudasar Zulfiqar
Sex: Male
Nationality: Danish
Age: 37Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)
Discharge Date: 2019/05/21

Before treatment:
The patient had no inducement to develop right thumb weakness 3 years ago and then gradually the condition aggravated and developed in the right arm. He was treated in a local hospital and was considered to have "amyotrophic lateral sclerosis". After that his condition continued to spread to the left arm and shoulder with muscle atrophy weakness. Two years ago he was clearly diagnosed with "amyotrophic lateral sclerosis." He took oral "riluzole" to control his disease but his condition has not been improved. The condition continued to progress gradually and developed to include weakness in both legs. 6 years ago he began to have low and weak pronunciation, accompanied by tongue muscle atrophy and coughing when drinking water. At present he cannot lift  his arms, grasping is difficult, he cannot complete eating, dressing and other movements. He needs help with getting up, can slowly turn over, walking function is still retained but the respiratory function and endurance are very poor. He can hardly take care of himself.
His spirit is not so good, his sleep and diet are normal. His urination and defecation functions are normal.

Admission PE:
Bp: 126/81mmHg, Hr: 98/min, breathing rate: 26/min, body temperature: 36.3 degrees. Height: 178cm, weight: 98Kg. The patient had good nutrition status and normal physical development. There was no injury or bleeding spots of his skin and mucosa, congestion in the throat, normal tonsils and a symmetrical chest. He had reduced respiratory activity, abdominal breathing, slightly low respiratory sounds in both lungs and no dry or moist rales. There was regular heart beat with irregular cardiac rhythm, no obvious murmur in the valves, a bulging abdomen with no masses or tenderness and a normal liver and spleen.

Nervous System Examination:
The patient was alert, had weak spirit, slurred speech, low voice and normal memory, orientation, and calculation abilities. His pupils were round and equal with a diameter of 3 mm, were sensitive to light and the eyeballs movement was flexible without nystagmus. He had a symmetrical forehead wrinkle and nasolabial fold, strong eyes closing and normal cheeks bulging ability. The tongue was in the middle, there was muscle atrophy and its movement was flexible. The bilateral soft palate was weak to lift, the uvula was in middle and the pharyngeal reflex was reduced. The neck turning and shrug abilities were weak. There was muscle atrophy in the 4 limbs’ proximal sides, bilateral sternocleidomastoid muscle, shoulder girdles and latissimus muscle. Muscle power of the proximal side and distal side of the right arm were level 2 and level 2- respectively; right gripping power was level 1+. Muscle power of the proximal side and distal side of left arm were level 2 and level 2-, respectively; left gripping power was level 2-. Muscle power of right and left leg were level 4- and 3+, respectively. Muscle tone of 4 all limbs was basically normal and the 4 limbs tendon reflex was reduced. Bilateral palm-jaw reflex, Hoffmann sign, Rossolimo sign and Babinski sign were positive. Bilateral deep and shallow sensation were normal by gross examination. Bilateral finger to finger, finger to nose, and fast alternate movement could not be done. Bilateral heel-knee-tibia test was slow and clumsy. 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, Edaravone and Riluzole), improve body environment (cocktail drugs), regulate his immune system and improve blood circulation. This was combined with rehabilitation training.   

After 14 days treatment the patient’s breathing frequency decreased to  19/min, blood oxygen saturation was more stable at 97%, his heart rate was 82/min, swallowing function got better and his speech was slightly clearer. Muscle power of the 4 limbs increased (proximal side of right arm, 3-; distal side of right arm, 2+; proximal side of left arm, 3; distal side of left arm, 3-; right gripping power, 2; left gripping power, 3-, right leg, 4; left leg, 4-). His walking endurance had also increased.

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