Sunny Hennigh-Amyotrophic Lateral Sclerosis-(USA)

Name: Sunny Hennigh
Sex: Female
Nationality: USA
Age: 38Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)
Discharge Date: 2019/11/18

Before treatment:   
Three years ago the patient had no inducement of right hand weakness, muscle atrophy and then the condition developed to the right arm and gradually involving the left arm too. After a series of examinations in the local hospital it was clearly diagnosed as "amyotrophic lateral sclerosis". Two years ago she began to have muscle spasms and muscle tremors with her hands, abdomen, calf and other parts of muscles which occasionally affected her nocturnal sleep (2 - 3 times per night). Her condition gradually progressed, she began to have walking posture changes, was easy to fatigue in lower extremity activity and she would occasionally fall. 8 months ago the patient could walk independently but was easy to fatigue, her breathing and language was basically normal, chewing  function was basically normal, occasionally she would cough when she was drinking water. The fine movement of both arms was poor and  arm lifting cannot be sustained. She needed the help of family members to complete showering. She came to our hospital in March this year her condition became better, her hands were more flexible and she could raise her arms easier, but one month ago her condition got worse again. She needed help with standing, showering and dressing, she walked slowly and had bad balance function, so she come to our hospital again.
Her spirit, sleep, appetite and  urination function are normal.

Admission PE:
Bp: 133/83mmHg, pulse rate: 81/min, breathing rate: 18/min, body temperature: 36.0 degrees. The patient had normal physical development, good nutrition, no ecchymosis of the skin and mucosa, a dry pharynx without congestion and no swelling of the tonsils. She had a symmetrical chest, clear respiratory sounds in both lungs, no remarkable dry or moist rales heard, strong heart sounds, regular heart rhythm, heart rate of 81/min and no obvious murmur heard. She had a bulging abdomen, no tenderness or rebound tenderness, normal liver and spleen and no edema in the legs.

Nervous System Examination:
The patient was alert, had good spirit and clear speech with normal calculation, memory and orientation abilities. She had equal and round pupils with a diameter of 3mm, reacting sensitively to light with free eyeball movement and no nystagmus. With a symmetrical forehead wrinkle and nasolabial fold, strong eye-closing, normal cheeks-puffing, tongue in the middle when extended with fasciculation, no muscle atrophy of the tongue, free tongue muscle movement, normal soft palate-lifting bilaterally, uvula in the middle and a normal gag reflex. There was normal head-lifting and neck-turning and a strong shrug. There was grade 3+ muscle power of the left arm, grade 4 muscle power of left upper abductor, grade 2+ muscle power of left upper adductor, grade 4- of left gripping power, grade 3 muscle power of right arm , grade 4 muscle power of right upper abductor, grade 2 muscle power of right upper adductor, grade 4- of right gripping power. There was grade 4 muscle power of both legs, remarkable muscle atrophy observed of both arms distal ends, bilateral interphalangeal muscle groups, major and minor thenars accompanied by general fasciculation. There was normal muscle tone of the 4 limbs, no tendon reflex of the 4 limbs, negative ankle clonus bilaterally, no abdominal reflex induced, negative palm-jaw reflex bilaterally, negative sucking reflex; negative Hoffmann sign, Rossilimo sign, and Babinski sign bilaterally. She had normal deep and superficial sensation bilaterally, unstable finger to nose test and fast alternate test; finger to finger test was only done with one finger on the left side and with the first 2 fingers on right side, stable and accurate heel-knee-tibia test bilaterally and a negative meningeal irritation sign.

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, nerve growth factors and neurotrophic factors), improve body environment (Edaravone), regulate her immune system and improve blood circulation. This was combined with rehabilitation training.   

Post-treatment:
After 14 days treatment her swallowing function became better with less choking. The muscle power of her bilateral upper abductors reached grade 4+, the bilateral upper adductors reached grade 3+, bilateral gripping power reached grade 4+, her left wrist-lifting got more flexible with stronger power and now wrist-lifting could be done with right hand too. The finger to finger test could be done with all fingers on both sides and her fingers got more flexible. She could drink and dress by herself, she raised her legs easier, her feet do flexion and extension easier, she walked longer and faster. She had better balance function, her walking and movement endurance got better than before, she could now stand on one leg with more stability and could last for over 10 seconds.