Bratislav Stojković -Amyotrophic Lateral Sclerosis (ALS) -(Serbia)

Patient's Name: Bratislav Stojković
Gender: Male
Age: 48 years old
Nationality: Serbia
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)

Condition upon Admission:
The patient experienced leg weakness without obvious cause 2.5 years ago, which gradually led to difficulty walking and reduced strength in both upper limbs. He also developed increased saliva production, slowed speech, unclear articulation, and easy fatigue, with a significant decrease in exercise tolerance. Occasionally, he experienced choking. He had been taking medications such as Riluzole, Amitriptyline, and Ursodeoxycholic Acid, but there had been no improvement in his condition, which continued to worsen.

Physical Examination upon Admission:
The patient's pulse was 78 beats per minute, respiratory rate was 22 breaths per minute, and blood oxygen saturation was 93%. There was mild cyanosis of the lips. His respiratory movement was diminished, and breath sounds in both lower lungs were slightly weakened, with no obvious dry or wet rales heard. Heart sounds were normal, with a regular rhythm, and no murmurs were detected in any of the heart valve areas. The abdomen was soft, and the liver and spleen were not enlarged upon palpation. There was no edema in both lower limbs.

Neurological Examination:
The patient was alert and in fair spirits. His articulation was unclear. He had a slight deviation of the tongue to the left, with decreased tongue muscle mobility and mild atrophy of the tongue muscles. He could puff his cheeks with strength, but his chewing ability was diminished. The elevation strength of both soft palates was reduced, and the uvula was in the midline. He had grade 3 strength in neck rotation and shoulder shrugging. His right upper limb had almost no movement, while he could move his left upper limb with difficulty. He could not grasp another person's hand with either hand. The proximal strength of the left upper limb was grade 2, with wrist flexor and extensor strength at grade 1+, grip strength at grade 1+, and interphalangeal strength at grade 1. The proximal strength of the right upper limb was grade 1+, with wrist flexor strength at grade 1, grip strength at grade 1, and interphalangeal strength at grade 1. The muscle strength in both lower limbs was grade 3-, with plantar flexor and dorsiflexor strength at grade 2. The patient could not stand independently and required significant assistance from 2 people; with assistance, he could shuffle walk 3-5 meters, with noticeable foot drop. When lying flat, he could elevate both lower limbs off the bed for 5 seconds. There was mild increased muscle tone in both lower limbs. Muscle atrophy was observed in all four limbs. The sensory function of the limbs was normal. The deep tendon reflexes in both upper limbs were diminished, the knee reflexes were active, and the Achilles reflexes were not elicited. The Babinski sign was positive bilaterally. Signs of meningeal irritation were negative.

Treatment Process:
The patient was diagnosed with "Amyotrophic Lateral Sclerosis (ALS)" upon admission. During the hospital stay, he received neural stem cell therapy to repair motor nerve damage, with mesenchymal stem cells used for neurotrophic, endocrine, and immune support. Additionally, he was treated with edaravone, riluzole, neurotrophic factors, reduced glutathione, and other medications as part of the CAST therapy, along with comprehensive rehabilitation treatment.

Post-Treatment Outcomes:
The patient's disease progression has stabilized, and significant improvements in motor function have been observed. His neck rotation and shoulder shrugging strength increases to grade 4. He demonstrates notable improvements in limb motor function and strength: the proximal strength of the left upper limb improved to grade 3; wrist flexor strength was at grade 2+, grip strength at grade 3, and interphalangeal strength at grade 2+. The proximal strength of the right upper limb is at grade 2+, with wrist flexor strength at grade 2, grip strength at grade 3-, and interphalangeal strength at grade 2. Both lower limbs exhibites strength at grade 4-, with plantar flexor and dorsiflexor strength at grade 3. The patient can perform elbow flexion movements more smoothly with the left upper limb, and the speed of internal and external rotation has noticeably increased. The right upper limb can perform slow internal and external rotations. He can grasp another person's hands with both hands and can resist gravity and some resistance. He can touch all fingers of the left hand except for the little finger, while the right hand can slowly perform finger opposition with the index and middle fingers. Due to the improvement in muscle strength, the patient's ability to stand and walk has enhanced, with a significant increase in balance ability; the need for assistance while standing has decreased considerably. With assistance, he can walk approximately 8-10 meters, and foot drop is no longer prominent.