Manpreet Singh Phul-Motor Neuron Disease-(USA)

Name: Manpreet Singh Phul
Sex: Male
Nationality: USA
Age: 47Y
Diagnosis: 1. Motor Neuron Disease (MND) 2. Hypertension (grade 2, high risk) 3. Type 2 Diabetes
Discharge Date: 2019/09/30

Before treatment: 
The patient has had progressive weakness of both legs for more than 6 years. He had no obvious cause of left foot drop 6 years ago and could not bend his toes 3 years ago. He went to the local hospital and was diagnosed as having motor neuron disease after an EMG examination. The disease gradually developed with weakness of the left leg and then right leg weakness  began to appear 2 years ago and he was unable to stand independently 1 year ago. An EMG examination performed again 3 months ago found that the arms began to be involved too and he felt pain in the lateral muscle of the left shoulder during exercise. At present the patient is unable to stand alone, he has drooping feet, reduced muscle volume and weakened strength of both legs, lower back and abdomen. There is no respiratory, swallowing or speech problems.
His spirit is normal, his sleep, diet, defecation and urination functions are basically normal but he has lost 12- 13 pounds of body weight. There is a previous history of hypertension and type 2 diabetes.

Admission PE: 
Bp: 145/95mmHg,pulse rate: 85/min, breathing rate: 18/min, body temperature: 36.2 degrees, height: 175cm, weight: 79kg.The patient has normal physical development, good nutrition, no cyanosis of the lips, a symmetrical chest, reduced chest mobility, weak respiratory sounds of both lower lungs and no dry or moist rales were heard. There was no bulging of the precordia, strong heart sounds, regular heart rhythm, no obvious murmur heard in the valves, a bulging abdomen, normal liver and spleen and no edema of the legs.

Nervous System Examination: 
The patient was alert, in good spirit, has clear speech, normal memory,  calculation and orientation abilities. Both pupils’ diameter was 3 mm, react sensitively to light with free eyeball movement, a symmetrical forehead wrinkle and nasolabial fold and the tongue was in the middle when extended. Fibrillation of the tongue muscle was observed, free tongue movement, no air leak when cheek-puffing, normal chewing, unremarkable soft palate-lifting and the  uvula in the middle. He had a  soft neck with normal neck-turning and shrug. There was reduced muscle power of the waist, back and abdomen, grade 5 muscle power of both arms, grade 5  bilateral gripping power, grade 3+ muscle power of both legs, no dorsal flexion of the left foot, reduced dorsal flexion of the right foot and normal muscle tone of the 4 limbs. There was a slightly reduced sensation of the left foot, normal sensation of other body parts, normal tendon reflex of the 4 limbs, normal Hoffmann sign, Rossolino sign and Babinski sign bilaterally. He had normal finger to nose, finger to finger and a fast alternate test bilaterally with a negative meningeal irritation sign.

After the admission he was diagnosed as having MND. He received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged nerves, replace dead nerves, nourish nerves (Edaravone, ganglioside, neurotrophic factors, nerve growth factor), improve body environment, regulate his immune system and improve blood circulation. This was combined with rehabilitation training and a non-invasive ventilator. 
After 12 days treatment the patient's exercise endurance was improved. His muscle strength, leg-lifting strength, waist and abdomen muscle strength, sitting function, foot extension, foot-lifting strength, foot-dragging condition and flexibility of limb movement were all improved. He could stand alone for 5-10 seconds without support and had restored the initial independent walking ability and improved the gait when walking.

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