Khaled Ben Abdel - MND (Pakistan) Posted on October 21, 2014

Name: Khaled Ben Abdel  
Sex: Male
Country: Pakistan
Age:44 years
Diagnoses: Motor neuron disease
Date: September 15, 2014
Days Admitted to Hospital: 18 days

Before treatment:
            The patient suffered from weakness of left lower limb without obvious inducement 3 and a half years ago. The disease aggravated gradually. He went to a local hospital, but didn't receive clear diagnosis. He received oral medication for treatment. The weakness progressed gradually and the patient visited many doctors and was diagnosed with Motor neuron disease. He received Riluzole 50 mg q12 h, but it didn't have any good effect. About 6 months ago, the patient's left lower limb suffered weakness. 5 months ago, both upper limbs suffered weakness too. He suffered from deep-voiced, weak muscle of breath and short of breath sometimes.

            From the onset of disease, the patient's emotion was stable. His defecation and urine were normal. His weight reduced by 8kg. The patient had no genetic disorders.

Admission PE:
            Bp: 125/97mmHg; Hr: 106/min, temperature 36.5 deg. Br: 22/min. The patient's nutrition was normal. His body type was normal. His skin and mucosa were normal, without yellow stains. The thoracic expansion was 1cm. The breathing was shallow. The respiratory sounds in both lungs were clear, with no obvious rales. Through auscultation:  the heart sound was low and blunt. The rhythm of his heartbeat was normal, with no obvious murmur in the valves. His abdomen was soft, with no pressing pain or rebound tenderness in the abdomen. The liver and spleen under the ribs were not enlarged. The oxygen saturation showed 93-96%.

Nervous System Examination:
             Khaled Ben Abdel was alert and his speech was slow. The endurance was poor when he spoke. His spirit was good. His memory, calculation abilities and orientation were all normal. Both pupils were equal in size, the diameter was 3.0 mm. Both eyeballs could move flexibly and the pupils reacted sensitively to light stimulus. The forehead wrinkle pattern was symmetrical. He was able to close his eyes with ease. The bilateral nasolabial sulcus was equal in depth. The tongue was at the center of his oral cavity and the movement of tongue was flexible. There was no obvious atrophy in the tongue. He had strong muscle to raise his soft palate. The uvula was in the center of the oral cavity. His neck was soft. He had strong muscle strength to turn his head and shrug his shoulders. The muscle strength of both upper limbs to outreach was at level 3. The muscle strength of both upper limbs to bend and stretch was at level 4. The hold power of both hands was at level 5. The muscle strength of both lower limbs was at level 1. The muscle strength of toes was at level 2. The muscle tone of both upper limbs was reduced. The muscle tone of both lower limbs was low. The tendon reflex of his four limbs had disappeared. There was paroxysmal fasciculation in both his upper limbs. There was obvious muscle atrophy in bilateral shoulder's supraspinatus and infraspinatus, big thenar muscles, thumb and forefinger interosseus muscle. The abdominal reflexes disappeared. Right side palm jaw reflex was positive. Bilateral sucking reflex was positive. The mandibular reflex was positive. The Hoffmann sign was negative. Bilateral Babinski sign was negative. The deep sensation and shallow sensation, using primary measures, were normal. He did the finger-to-nose test, the rapid rotation test and fingers coordinate movement test in a stable manner. He had difficulty with the heel-knee-shin test. There were no signs of meningeal irritation.

Treatment: 
            We initially gave Khaled Ben Abdel a complete examination. The patient received treatment for nerve regeneration and to activate stem cells in vivo. He received treatment to improve his blood circulation in order to increase the blood supply to the damaged neurons and to nourish them. He also received treatment for nerve regeneration and also to protect all viscera function. At the same time, he received non-invasive ventilator to increase the oxygen supply. This was accompanied with daily physical rehabilitation training.

Post treatment:
            After comprehensive treatment, the muscle strength of upper limbs to outreach is at level 4-. The muscle strength of upper limbs to bend and stretch is at level 5-. There is obvious muscle contraction of both lower limbs. The oxygen saturation has increased from 93-96% (at admission) to 95-98%.