Enzo Tessari-Amyotrophic lateral sclerosis (ALS)-(Italy)

Patient's name: Enzo Tessari
Gender: Male
Age: 69 years old
Nationality: Italy
Diagnosis: Amyotrophic lateral sclerosis (ALS)

Admission status:
Patient has been experiencing progressive weakness of limbs for over a year, with worsening of language function impairment for one month. He started to experience finger weakness, difficulty cutting nails, and gradually developed difficulty walking and reduced upper limb strength one year ago. He also had frequent limb muscle spasms that had seriously affected his sleep. He had no difficulty swallowing and has no water coughing. He had a history of hypertension and hyperlipidemia.

Physical exam upon admission:
Patient's pulse rate was 84 beats per minute, respiratory rate was 20 breaths per minute, blood pressure was 129/87 mmHg. Patient's height was 175 cm, weight was 79 kg. His lips were normal without cyanosis. His respiration was clear in both lungs without hearing any dry or wet rales. His heart sounds were normal and regular, without any murmurs at various cardiac valves. His abdomen was flat and soft, with no palpable liver or spleen. No edema is present in his lower limbs on both sides.

Neurological examination:
Patient was clear-headed and in good spirits. His speech was slightly unclear. His eye movements were flexible in all directions. The symmetry of the bilateral nasolabial folds and forehead wrinkles was normal, and his tongue was in the middle with no atrophy. He had strong cheeks puffing and normal chewing force. The bilateral soft palate lift was strong, and the uvula was centered. His neck flexion and shoulder elevation muscle strength was grade 5. He had grade 3 muscle strength in his left upper arm and forearm, with grade 3+ muscle strength in his left wrist, and grade 3+ grip strength in his left hand. He had grade 3+ muscle strength in his right upper arm and forearm, with grade 4 muscle strength in his right wrist and grip strength. His left lower limb had grade 3+ muscle strength，with grade 3+ muscle strength in the plantar flexion of the foot, with grade 2+ muscle strength in the dorsiflexion of the foot, and his right lower limb had grade 4 muscle strength, with grade 3+ muscle strength in the plantar flexion of the foot, with grade 3 in the dorsiflexion of the foot. He was unable to stand on one leg on the left side and could stand on one leg for 2 seconds on the right side. He had normal muscle tone in his limbs, but he had visible muscle twitching in his upper limbs. He frequently experienced muscle spasms in his limbs and waist and back areas. He had obvious muscle atrophy in his left upper limb. His sensation in his limbs was normal. His tendon reflexes were generally normal in his limbs. His left lower limb Babinski test was positive, and his right lower limb Babinski test was suggestively positive. His left fingers to nose and finger to finger tests were slow, while his right hand was fine. His left hand-switching test was slow and clumsy, while the right side was normal. His left leg heel-knee-shin test was slow, and his right leg heel-knee-shin test was completed. His serum creatine kinase was significantly elevated.

Treatment process:
The patient was admitted with a clear diagnosis of "amyotrophic lateral sclerosis". During his stay in the hospital, he received neural stem cell therapy to repair motor nerve damage, mesenchymal stem cell therapy to enhance nutritional support for the nerves, endocrine, and immune system, and adjuvant medications such as edaravone, riluzole, and nerve growth factor. Additionally, he received comprehensive rehabilitation treatment.

After treatment:
The patient's motor function has significantly improved, with a 90% reduction in muscle spasms throughout his body. His sleep has also improved significantly. His limb movement function has improved significantly, with significant improvement in muscle strength: His upper left limb's proximal and distal muscle strength has improved to grade 4+, and his grip strength has improved to grade 4+. His right upper limb's proximal and distal muscle strength is grade 5-, and his grip strength is also grade 5-. His left lower limb's muscle strength is grade 4, and his plantar flexion is grade 4, while his dorsiflexion is grade 3+. His right lower limb's muscle strength is grade 5-, and his plantar flexion and dorsiflexion are also grade 5-. He can stand on his left leg for 2 seconds and on his right leg for about 5-10 seconds. His hand-switching test speed has increased and become more flexible, as compared to when he was admitted. His ability to complete the heel-knee-shin test on his left leg has improved in terms of both completion and accuracy, and his motor balance and flexibility have significantly improved. His distance walked independently has increased, as well as his energy, physical stamina, and exercise endurance, which have all significantly improved. His creatine kinase level has significantly decreased.