Imad - Motor neuron disease (Iraq) Posted April 23, 2014

Name: Imad Jalal Ibrahim                
Sex: Male
Country: Iraq
Age: 33
Diagnosis: Motor neuron disease
Date: March 16, 2014
Days Admitted to Hospital: 29 days

The patient suffered from weakness of the lower limbs 5 years ago, without obvious incentive. This was accompanied with muscles jumping and pain. The patient suffered from slight muscle atrophy and the disease progressed gradually. He also suffered from weakness of the upper limbs and muscle atrophy in both upper limbs. He was diagnosed with motor neuron disease. He received treatment in a local hospital, but the effect was not good. His disease was aggravated in 1 year, and he didn't care for himself. The main symptoms before treatment: there was obvious muscle atrophy in four limbs, the muscle strength of four limbs was weak, but the lower limbs was more severe. He had difficulty in bending and stretching his four limbs. He couldn't turn over, sit-up or stand from sitting position. He could maintain standing position for a transient time. He could walk by himself.

From the onset of disease, the patient had normal spirit, diet and sleep. His had normal defecation. His weight has increased than before. He has a brother who has the same disease.

Admission PE:
Bp: 116/82mmHg; Hr: 68/min, temperature: 36 degrees. Br: 18/min. The skin and mucosa were normal, with no stained yellow spots or petechia. The respiration in both lungs was clear, with no dry or moist rales. The heart sounds were strong, the cardiac rhythm was regular, and there was no obvious murmur in the valves. The abdomen expanded and was soft, with no pressing pain or rebound tenderness. The liver and spleen were found to be normal through palpation. He had difficulty with bending and stretching his four limbs. He couldn’t turn over, sit-up or stand from sitting position. He could maintain standing position for a transient time. He could walk by himself.

Nervous System Examination:
Imad Jalal Ibrahim was alert and he was in good spirits. His speech was clear. The memory, calculation abilities and orientation were normal. The diameter of both pupils was 3.0mms. Both pupils had sensitive responses to light stimulus. The eyeballs could move freely. There was horizontal nystagmus in both eyes. He had the ability to bring together both eye balls. The forehead wrinkle pattern was symmetrical. The eye closing ability was strong. The tongue was centered in the oral cavity. The teeth were shown without deflection. He had strong muscle to raise his soft palates. The pharyngeal reflex existed. There was congestion in pharyngeal. The tonsil was enlarged, 2 degrees. Bilateral supraspinatus, infraspinatus, latissimus dorsi, deltoid, biceps brachii, triceps brachii muscle and forearm muscles had obvious muscle atrophy. The abduction muscle strength of both upper limb's near-end was at level 4-, the adduction of both upper limb's near-end was at level 3. The muscle strength of both upper limbs far-end was at level 3-. The grasp power of both hands was at level 2. The muscle strength of both lower limbs' near end was at level 2- and both lower limbs far end was at level 1+. The muscle tone of four limbs was almost normal. The tendon reflex of his four limbs was reduced. The abdominal reflexes were normal. Bilateral palm jaw reflex was negative. Bilateral Hoffmman sign and Rossilimo sign were negative. Bilateral Babinski sign was negative. The bilateral deep sensation and shallow sensation through coarse measure were normal. He did the finger-to-nose test, the rapid rotation test and the digit opposition test in a stable manner. He had difficulty with the heel-knee-shin test. There were no signs of meningeal irritation.

Treatment:
The patient was given a complete examination. He received treatment for nerve regeneration and to activate stem cells in the body. He received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and also to nourish the neurons. He also received treatment to promote nerve repair. This was combined with physical rehabilitation training.

Post-treatment:
At present, Imad Jalal Ibrahim's condition has improved. The exercise tolerance has increased. He does not easily get tired after the same amount of movement before therapy. The muscle strength of his four limbs has increased than before. He can support himself with hands and knees for about 20 seconds. The muscle strength of both upper limb's near end is at level 4 and the far end is at level 3+. The grasp power of both hands is at level 3. The muscle strength of both lower limb is at level 2+. He can walk 5-10 meters distance by himself.