Roman Petrukhin-Spinal Muscular Atrophy(Russia)

The second round of treatment:

Name: Roman Petrukhin
Spinal Muscular Atrophy(SMA)
Discharge Date:

Before treatment:
The patient was born by cesarean due to intrauterine hypoxia 6 years ago. His Apgar score was 7-8 and he was diagnosed with perinatal encephalopathy. When he was 7 months old he was unable to sit and he was diagnosed with SMA in 2012. He took oral Salbutamoul for 2 years and  also did physical treatment but his condition was not improved. He went to our hospital 2 years ago. At present he has thoracocyllosis, his arms cannot move well and the muscle power of his legs is 1-2.
His spirit and diet are normal. His urinantion and defecation functions are normal.

Admission PE:
Bp: 106/58mmHg, Hr: 79/min, breathing rate: 21/min, body temperature: 36.8 degrees, height was 118cm, weight was 22kg. There is no injury or bleeding spots of his skin and mucosa, no blausucht.  There is chest development malformation, he mainly depends on abdominal breathing. The chest movement reduced when he was breathing. The respiratory sounds in both lungs were clear with no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was bulging with no masses or tenderness. There is no edema in the legs.

Nervous System Examination:
Patient was alert with clear speech. His orientation and cognitive functions were normal . Both pupils were equal in size and round, diameter of 3mm, react well to light and the eyeballs can move freely. There was no nystagmus, eyesight was normal by gross measure. He had tongue muscle atrophy but his tongue can move freely. Patient could not turn his neck or shrug powerfully. He could sit, could not roll over in bed, could not sit up, stand or walk. The muscle power of the arms was 3- degrees, hands grip force was 2 degrees. The arms could lift and touch his forehead. The  proximal side muscle power of the legs was 2- degrees. He could not stretch his legs. Left leg was at 170 degrees, right leg was 150 degrees. There was left heel contracture, right side strephenopodia. He could perform adduction and abduction movement of the legs when he was bending his knee and hips. His legs could make a slight movement when he stretched his knees and when he bent the knees he could only move his legs flatly in bed occasionally. 4 limbs muscle tone was reduced. Bilateral biceps reflex, radial periosteal reflex and patellar tendon reflex disappeared. His Achilles tendon reflex could not be induced by examination, bilateral palm-jaw reflex and grasp reflex were negative. Bilateral Hoffmann sign and Babinski sign were negative. He could perform the finger to nose test fast alternate movement and finger opposite movements in a stable and slow way. He could not perform the heel-knee-tibia test. Sensory examination was normal. Meningeal irritation sign was negative.

After the admission he received 3 times nerve regeneration treatment(neural stem cells and mesenchymal stem cells) to repair his damaged nerves, replace dead nerves, nourish nerves, regulate his immune system and improve blood circulation. This was done with rehabilitation training.     

After 13 days treatment his spirit was better, he could lift his arms much better, his left leg cold move in bed in a much more flexible manner and with a much bigger range. The grip power of both hands was increased, he could now grasp with his hands.

The first round of treatment:
Date of Admission: Mar.14, 2016

Before treatment:
Roman was delivered by cesarean section because he was anoxic while in his mother’s uterus 4 years ago. Apgar score: 7-8. Roman was diagnosed with perinatal cerebropath and ataxia syndrome. When Roman was 7 months old, his parents discovered that he was not able to maintain a sitting position, so they took him to the local hospital where he had a gene examination completed. The results showed there was no exon 7-8SMN on the homozygote sequence, so he was diagnosed with spinal muscular atrophy in March 2012. The doctor prescribed Salbutamoul for oral use for 2 years. At the same time, Roman had physical therapy including massage and swimming but was ineffective. At present, he has thoracic deformity, and is not able to move his upper limbs very well. The muscle power of the lower limbs is between level 0 and level 1.
Roman’s mood was good. His liquid intake and appetite were normal.. He had atrophy of the muscles and he was thin. His urine routine and bowel movements were normal.

Admission PE:
Temperature: 37.1℃, Hr: 120/min, Br: 25/min, Bp: 95/55mmHg. Height: 107cm, weight: 14kg. There was no breakage or hemorrhagic spots on the skin. Roman had thoracic deformity. The respiratory sounds in both lungs were clear.  The abdominal movements were weak when he breathed. There were no obvious dry or moist rales. The cardiac rhythm was regular, with no obvious murmur. There was abdominal bulging and the abdomen was soft, with no palpable masses. The liver and spleen were normal. There was no swelling in the lower limbs. The examination results showed signs of slight anemia. 

Nervous System Examination:
Roman petrukhin was conscious and alert. His language skills were normal. The insight ability and orientation were normal. Both pupils were equal in size, the diameter was 3.0mms. Both eyeballs could move flexibly and the pupils reacted normally to light stimulus. There was no obvious nystagmus. The vision and vision field were normal. Roman had difficulty shrugging his shoulders and turning his head in either direction. He was able to maintain a sitting position but he was not able to turn over on the bed, sit up, stand or walk. The muscle tension of all four limbs was normal. The muscle power of both upper limbs was at level 3, the gripping strength was at level 3, the proximal muscle power of both lower limbs was at level 1+ and the distal muscle power of both lower limbs was at level 0. The left lower limb was at an angle of 170 degrees and the right lower limb was at an angle of 150 degrees. The left heel was contracted. The right foot was crossed. When Roman bent his hips and knees, he was able to adduct and abduct the lower limbs. When he extended his knees, he was able to move the lower limbs slightly on the bed, and when he bent his knees, he was able to move his lower limbs occasionally. There was no bilateral biceps reflex, radioperiosteal reflex or patella tendon reflex. The Achilles tendon reflex was normal. The bilateral pathological result was negative. Roman was able to do the finger-to-finger test, rapid rotation test and finger-to-nose test correctly but slowly. Roman couldn’t do the heel-knee-shin test. The sensory examination results were normal. There were no signs of meningeal irritation.     

After admission, Roman Petrukhin was diagnosed with spinal muscular atrophy. He received 3 neural stem cell injections and 3 mesenchymal stem cell injections to increase the number of normal nerves, repair the damaged nerves and produce new nerves. The treatment provided enough nutrition for the nerves and improved the blood circulation and regulated the immune system. The treatment was accompanied with daily physical rehabilitation training.

After 2 weeks of treatment, Roman’s condition was better. He had more power and gained 1kg. He felt more power in his right hand, he was able to bend his left knee easier than before, and when he bent his knees, the adductor muscle power was higher. His resistance improved. He was able to move his knees and ankles better than before. He was able to turn over from the prone position to the supine position. He was able to maintain a sitting position for a longer period of time and his posture while sitting improved.

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