Naomi-Multiple System Atrophy-(Israel)

Name: Naomi
Sex: Female
Nationality: Israeli
Age:60Y
Diagnosis: Multiple System Atrophy (MSA)
Discharge Date: 2018/10/18

Before treatment:
The patient walked slowly 8 years ago, she felt stiff in her body and she was diagnosed with Parkinson's disease. She took amantadine for treatment but her condition was not improved. She used an aid for walking 5 years ago and her balance function was bad. 4 years ago her condition got worse fast, she spoke slower, swallowed slowly and choked sometimes. She went to hospital and was diagnosed with MSA. At present she speaks in an unclear way, swallows slowly, is unable to sit up, cannot stand up and it is hard for her to walk.  Her balance function is bad, she can’t control her urination function well, her diet and sleep are normal. She uses a urinal pad 24 hours a day and  uses medicines for defecation.

Admission PE:
Bp: 127/81mmHg, Hr: 74/min, breathing rate: 18/min, body temperature: 36.4 degrees. Blood oxygen concentration was 88-90%. Height 170cm, weight 80Kg. The patient is wheelchair bound, her nutrition status is good and she has  normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion and her tonsils do not have swelling. The respiratory sounds in both lungs were not very clear and  there was some rhonchi. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was mildly bulging and soft, had a drum percussion sound with no masses or tenderness. The liver and spleen were normal. There was no edema of the legs.

Nervous System Examination:
Patient was alert, had slurred and slow speech, her memory,  comprehension and calculation abilities were normal. Both pupils were equal in size and round, had a diameter of 2.5 mm, the reaction to light was sensitive, there was no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical, she could make her tongue extend out to lip side, there was no tongue muscle tremor or atrophy and the tongue muscle could not move in a flexible way. The soft palate could lift powerfully and the uvula was in middle. She could turn her neck normally. The patient could not roll over in bed herself and cannot sit or stand up by herself. The arm muscle power was 4 degrees, the leg muscle power was 3- degrees, the 4 limbs muscle tone were normal, arms tendon reflex was normal and her patellar tendon reflex and Achilles tendon reflex could not be induced by examination. Bilateral Hoffmann sign and Rossilimo sign were negative, the bilateral Palm-jaw reflex was positive. The Babinskli sign of both sides was positive. The sensory examination was normal. She could perform the finger opposite movement and finger to nose test slowly, the fast alternate movement was clumsy, she could not perform the heel-knee-tibia test and the meningeal irritation sign was negative.

Treatment:
After the admission she received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged nerves, replace dead nerves, nourish nerves (ganglioside and neurotrophic factors), regulate her immune system and improve blood circulation. This was combined  with rehabilitation training.     

Post-treatment:
After 14 days treatment her speech was much clearer, she spoke louder and the swallowing function improved. The 4 limbs muscle power increased with the arm muscle power now 4+ and the leg muscle power 4- degrees. She could maintain a standing balance and walk with support much easier. The blood oxygen concentration was 92-98% and her respiration function was improved.

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