David Samet-Multiple Sclerosis-(Israel)

Name: David Samet
Sex: Male
Nationality: Israeli
Age: 50Y
Diagnosis: Multiple Sclerosis(MS)

Before treatment:
The patient was diagnosed with MS 10 years ago. He used interferon and steroids for 3 years then in 2012 he began to use Tysabri for treatment and his condition became stable. In October 2015 his condition got worse again. His legs became weak and he walked in an abnormal manner. He received methylprednisolone intravenous injections, his condition became better and he could stand and walk. In July 2016, his condition became worse again so in February 2017 he had methylprednisolone and Tysabri injections once a month but his condition still declined. The muscle power of his arms was weak and he walked slowly. For now, he is unable to stand up, sit up, walk or turn over his body.
His spirit is normal, his diet is normal but he does not sleep well. He has frequent micturition, his defecation function is normal.

Admission PE:
Bp: 125/68mmHg, Hr: 73/min, body temperature: 36.7 degrees. weight: 70Kg. Nutrition status is good with normal physical development. There was no bleeding spots or yellow stains on his skin and mucosa, no tonsil swelling, chest development is normal and the respiratory sounds in both lungs were clear with no dry or moist rales. The heart beat is strong with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft and flat with no masses or tenderness. Liver and spleen were normal, shifting dullness was negative. The spinal column was normal and there was no edema of the legs.

Nervous System Examination:
Patient was alert and his mental status was fine with clear speech. The memory, orientation and calculation abilities were normal. Both pupils were equal in size and round, diameter of 3.0 mm and react well to light showing no eyesight problem and no nystagmus. His  eyesight was normal by gross examination with no diplopia and no visual field loss. Bilateral forehead wrinkle and nasolabial groove are symmetrical, he can make his  tongue extend out while it is skewed to the left side slightly. There was no tongue muscle atrophy, showing the teeth was normal. the uvula was in middle and the soft palate can lift as normal. His neck could move freely and he can shrug as normal. The muscle power of the arms was was 5- degrees, left leg muscle power was 2+ degrees, right leg was 2 degrees. The muscle tone of the arms was normal and of the legs it was higher. The right arm biceps reflex was active, The radial periosteal reflex of the legs was normal, left arm tendon reflex was normal, patellar tendon reflex was hyperactive. The abdominal reflex was present, the bilateral palm,-jaw reflex was negative, the Hoffmann sign of both sides was negative, bilateral Babinski sign was positive and the ankle clonus was negative. His sensory examination was normal and he can perform the finger to nose test and finger opposite movement as normal. The fast alternate movement of both sides was normal. He could not perform the lower limbs heel-knee-tibia test because of weakness (he can not stand independently). The meningeal irritation sign was negative.

Treatment:
After the admission he received 3 times nerve regeneration treatment to repair his  damaged nerves, replace dead nerves, nourish nerves, regulate his immune system and improve blood circulation. This was done along with rehabilitation training.     

Post-treatment:
After 14 days treatment his leg muscle tone decreased, the movement ability got better and his walking gait was much better than before with the walking pace increased. The muscle power of the legs increased with the muscle strength of his left leg now level 3 and the right leg level 3-.

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