Sarah Anne Olsen-Amyotrophic Lateral Sclerosis-(USA)

Name: Sarah Anne Olsen
Sex: Female
Nationality: USA
Age: 31Y
Diagnosis: 1.Amyotrophic Lateral Sclerosis 2. Hypothyroidism
Discharge Date: 2020/01/13

Before treatment: 
There was no obvious inducement in 2017 as the strength of the patient's left leg weakened and gradually aggravated. This was followed by the weakness of the right leg and an abnormal walking gait. The disease worsened progressively, accompanied by muscle bundle tremor, muscle atrophy and later involved both arms. At the local hospital she was diagnosed with ALS in May 2018 and began to be treated with Riluzole 50mg twice a day. However, the patient's condition continued to progress,  both her legs could not walk independently at the end of 2018. At present she is unable to do daily activities by herself, she can’t turn over on the bed, sit up, maintain a sitting position, stand, walk, brush teeth, wash, etc. She needs other people to feed her. She has no sensory disorders, her diet, speech and swallowing are normal but she needs ventilator-assisted breathing. 
Her spirit is normal, she has normal diet, sleep, urination and defecation functions and she has lost 12Kg of weight in the last year.

Admission PE: 
Bp: 118/76mmHg, Hr: 110/min, breathing rate: 21/min, body temperature: 36.5 degrees, weight: 50kg.There are no yellow stains or blood spots on her skin, there was no congestion in the pharynx and no enlargement of the tonsils. Thoracic respiratory mobility is decreased, bilateral lung respiratory sounds weakened and no obvious dry-wet rales were heard. There is a strong heart sound, arrhythmia, heart rate 110/min and no obvious murmur in each valvular area. The abdomen was flat and soft, there was no press pain or rebound pain, normal liver and spleen and there was no edema in the legs.

Nervous System Examination: 
Patient was alert, in good spirit and had clear speech with normal memory,  calculation and orientation abilities. The diameter of both pupils was 2.5 mm, reacting sensitively to light with free eyeball movement, symmetrical forehead wrinkle, good power with eye closing. There was mild muscle atrophy of the tongue, free tongue movement, no air leakage when cheek-puffing, normal chewing, normal soft palate-lifting and normal swallowing ability. She had a weak neck, needs help to hold up her head and  she couldn’t shrug. There was grade 2 muscle strength of the arms, bilateral wrist extensor strength was grade 3, left wrist flexion strength grade 2, right wrist flexion grade 2 +, left hand grip strength grade 4, right hand grip strength grade 3. The muscle strength of the left leg was 1 + grade, and the right leg was 2- grade. There was decreased muscle tension in the extremities and the skeletal muscles of the extremities were atrophied. The tendon reflex of the extremities was obviously weakened and the bilateral achilles tendon reflex was not induced. Bilateral Hoffmann sign was not elicited, bilateral Babinski sign was positive. The depth and shallow feeling of both sides felt normal, normal finger to finger test, the rapid rotation test was difficult to do, the bilateral finger to nose test and bilateral heel-knee-tibia test can not be completed due to muscle weakness. The meningeal irritation sign was negative.

Treatment:
After the admission the patient was diagnosed with ALS. She received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged nerves, replace dead nerves, nourish nerves (Edaravone, ganglioside,neurotrophic factors, nerve growth factor), improve body environment, regulate her immune system and improve blood circulation. This was combined with rehabilitation training and a non-invasive ventilator.   

Post-treatment:
After the treatment the respiratory function of the patient was improved and the condition of hypoxia was improved. The heart rate recovered from a long term 110 beats / min  to 85 / min to 90 beats / min. The patient's exercise endurance, head and neck support and arm strength were increased. The movement and rotation of both arms and grip strength of both hands were increased with left hand grip strength 4 +, right hand grip strength 4. The left leg muscle strength was 2 -, right leg muscle strength 2 +, arm muscle strength increased by 10% while the legs muscle strength increased by 20%. She can now place her knees down on the bed and hold up her body and her physical fitness is increased.

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