Naif Abdulaziz Alghanem-Multiple Sclerosis-(Saudi Arabia)-Posted on March.31th, 2017

Name: Naif Abdulaziz Alghanem
Sex: Male
Nationality: Saudi Arabian
Age: 37Y
Diagnoses: 1. Multiple Sclerosis 2. Secondary Epilepsy
Date of Admission: November 13th, 2016
Treatment hospital/period: Wu Medical Center/16days

Before treatment:
Naif had chronic headaches 3 years ago and he didn’t know the reason. It lasted for 3 months and the doctor prescribed oral anodyne. His condition was stable but it occurred again but he didn’t go to hospital. 4 months later, Naif felt his legs were heavy and had weakness, the sensation was not good. This was accompanied by whole body muscular spasms. Each attack was around 10 minutes, and his family members took him to hospital where they did a brain MRI, several other tests and EEG. The brain MRI showed: leucodystrophy/ demyelination of corpus callosum, right front lobe had rare sharp wave and intermittent slow waves and so he was diagnosed with 1. Multiple Sclerosis 2. Secondary Epilepsy. The doctor prescribed Methylprednisolone intravenous treatment and his condition improved. He could walk, but several months later, his condition became worse again. Hormone therapy made no improvement and he then received blood transfusions but there was still no improvement. At present, he is unable to sit up, stand, walk or roll over and so he needs full care. He was unable to control his bladder or bowel action several months ago. He wants a better life so he went to our hospital.
His mental health, appetite and sleep are all bad and he lost 20 kgs.

Admission PE:
Bp: 145/95 mmHg, Hr: 82/min, body temperature: 36.0 degrees. Nutrition status is poor but he has normal physical development. There is no injury or bleeding spots of his skin and mucosa, he had throat congestion,  coughs with a white dilute sputum but tonsils have not swollen. The chest has normal development, lung breathing sounds are clear and there are no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and there is no obvious murmur in the valves. The abdomen was flat and soft, with no masses or tenderness. The liver and spleen were normal, shifting dullness is negative. The spinal column is normal but his ankles show slight edema. The ALT level was a little higher than normal.

Nervous System Examination:
Patient was alert but his mental status is weak and speech is not very clear. His response ability and comprehensive ability are less than normal and he cannot complete the examination of calculation, memory and orientation ability. Both pupils were equal in size and round, with a diameter of 3 mm, they react well to light and the eyes  move freely. No nystagmus. His eyesight is normal by gross measure, no diplopia, no visual field deficit. Bilateral forehead wrinkle and nasolabial fold are symmetrical and he can show his teeth normally. Tongue is in middle with no tongue muscle atrophy. Soft palate can lift as normal. He can turn his head freely, and he can shrug strongly. The  muscle power of the right arm is 5 degrees, grip force is 4 degrees. The muscle power of the left arm is 1 degree, grip force is 2 degree. The muscle power of the right leg is 2 degrees and  left leg is 0.  Muscle tone of arms and left leg are basically normal. The right leg is slightly higher. Tendon reflex of  arms and legs are active, abdomen reflex is normal. Palm-jaw reflex is negative. Bilateral Hoffmann sign is positive, Babinski sign of both sides are positive. The ankle clonus are negative. His needle sensation on the left side of the body is weaker than normal, but the patient can not fully express that because of his poor comprehensive ability. The finger to nose test and fast alternate movement of the right side are slow and he only can do the 2 finger opposite movement by examination. He can not perform the finger to nose test and fast alternate movement on the left side, and he can only perform the  opposite finger test with his second finger. Patient can not perform the heel-knee-tibia test and the meningeal irritation sign is negative.

Treatment:
After admission the patient received a detailed body examination. He had high blood pressure with the highest reading 150/110 mmHg. Doctors gave the patient some medicines to control his high blood pressure and then his blood pressure became much more stable.
The diagnosis are: 1. Multiple Sclerosis 2. Secondary Epilepsy.
The patient's mental status is not very stable and he refused to take food, medicines and rehabilitation training frequently.  Based on his condition, doctors gave the patient 3 neural stem cell injections and 3 mesenchymal stem cell injections to repair his damaged motor nerves and to replace dead nerves with new injected stem cells, nourish nerves and improve blood circulation. This was to stabilize his mental status, adjust his anti-seizure medicines, protect the liver function and adjust his blood pressure and heart rate, etc. This was combined with some psychological counseling. 

Post-treatment:
After 16 days of treatment he can cope with the therapy much better and his blood pressure and heart rate are normal. Liver function is normal and there have been no seizure attacks. He has no facial cramping. His movement ability is better than before and his muscle power on the left side of his body has increased by 1 degree. He is able to raise his left arm off the bed and his  joints are more flexible. There are muscle contractions in the left leg and he  can move his left toe a little.