Abdulla Mohamed Yahya-Amyotrophic Lateral Sclerosis-(UK)

Name: Abdulla Mohamed Yahya
Sex: Male
Nationality: UK
Age: 62Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS) 2. Hypertension (1 degree)

Before treatment:
The patient was unable to speak clearly in Dec. 2014. His left hand was weak and as the disease progressed the left side of his body became weak. He went to a local hospital in June 2015 and did some tests and he was diagnosed with ALS. He was prescribed Riluzole 50 mg twice a day. His disease was controlled, but after that it became hard for him to buy the medicines so he stopped using it and his disease progressed fast. Then he started to use the medicines again but his language ability was bad and he couldn’t speak for a year. His swallowing function and muscle power were both decreased, he was unable to stand or walk 6 months ago and he had gastrostomy surgery. He did  stem cell treatment in India in Jan and June 2017 but there was no improvement. He wants a better life so he came to our hospital.
His spirit is good, his appetite is not good, he sleeps well, he has constipation, so he uses lactulose oral solution to help him defecate. He has lost 40 Kgs.

Admission PE:
Bp: 133/83mmHg, Hr: 67/min, breathing rate: 20/min, body temperature: 36.0 degrees. Height: 168cm, weight: 38 Kg. He has normal physical development but his nutrition status was bad. There is no injury or bleeding spots of the skin and mucosa, there are many secretions in the mouth, chest develop was sound but the chest movement range decreased when he was breathing. The respiratory sounds in both lower lungs area were very weak but 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 flat and soft with no masses or tenderness.  The liver and spleen were normal. The shifting dullness was negative, spinal column was normal. There was slight pitting edema in the feet, dorsalis pedis pulse was good.

Nervous System Examination:
Patient was alert and mental status was good. He could not speak but the memory, orientation and calculation abilities were normal . Both pupils were equal in size and round, diameter as 3.0 mm, react well to light and the eyeballs can move freely. Bilateral forehead wrinkle is symmetrical. He could not extend the tongue out, has tongue muscle atrophy but showing the teeth was normal. He could not bulge the cheek, chewing ability had declined obviously, the soft palate could not lift and the uvula was in middle. There was severe muscle atrophy in both shoulder girdles, 4 limbs, thenar muscles, and hands interosseous muscles. Neck was soft, he could turn the neck and shrug his shoulders well. Muscle power of the right arm was 4+ degrees, left arm was 4- degrees. The grip force of the left hand was 5- degrees, right hand was 4- degrees. Muscle power of the left leg was 3- degrees,  right leg was 3 degrees. Muscle tone of all four limbs were normal. Tendon reflex was normal, Hoffmann sign of both sides were negative, bilateral Babinski sign were negative. Right side finger to nose test, fast alternate and finger opposite movement were basically normal. Left side finger to nose test and fast alternate movement were slow. He could not perform left side finger opposite movement. Patient could not perform the Heel-knee-tibia test because of weakness. The meningeal irritation sign was negative.

Treatment:
After the admission, he received related examinations and 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 sleeping was better，his expression was relaxed and he had a smile sometimes. His drooling reduced, appetite increased and gastric esophageal reflux symptoms was controlled well. He put on about 4kg of weight. His breathing function got better, the heart function was stronger and his weak condition improved. The power of his body was increased. The muscle strength of his right arm increased to level 5-, right grip power was level 5-, left arm muscle strength rose to level 4+,  muscle strength of the left leg increased to level 3+, right leg increased to level 4-. The tongue muscle movement and swallowing function were better than before.