Helen-Amyotrophic Lateral Sclerosis-(Australia)

Name:Helen
Sex: Female
Nationality:Australian
Age: 34Y
Diagnosis: Amyotrophic Lateral Sclerosis( ALS)   
Discharge Date: 2019/05/26

Before treatment:
Two and a half years ago the patient had no inducement of right hand weakness or muscle atrophy and then the condition developed in the right arm and also gradually involving the left arm. 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 in her hands, abdomen, calf and other parts of muscles which can occasionally affect nocturnal sleep (2-3 times per night). Her condition gradually progressed, she began to have walking posture changes, found it easy to fatigue with any lower extremity activity and she would occasionally fall. At present she can walk independently but it is easy for her to fatigue. Her breathing and language is basically normal, chewing  function is basically normal, occasionally she will cough when she drinks water, her fine movement of the arms is poor and the lifting ability cannot be sustained. She needs the help of family members to complete a shower.
Her spirit, sleep, appetite and urination functions are all normal. She has a history of recurrent migraines and often takes painkillers. In the past 4 years, there has been intermittent diarrhea which has alleviated itself without oral drugs.

Admission PE:
Bp: 123/78mmHg, Hr: 71/min, breathing rate: 18/min, body temperature: 36.3 degrees. Height 172cm, weight 89Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion and her tonsils are not swollen. Chest development was normal, the respiratory sounds in both lungs were clear and there were no dry or moist rales. The heart beat is powerful with regular cardiac rhythm at 68/min and with no obvious murmur in the valves. The abdomen was bulging and soft with no masses or tenderness. The liver and spleen were normal and there was no edema of the legs.

Nervous System Examination:
Patient was alert and had clear speech. Her memory, comprehension and calculation abilities were normal . Both pupils were equal in size and round with a diameter of 3 mm, the reaction to light was sensitive, no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical, she can close eyes powerfully, could make her tongue extend out normally, there was no tongue muscle tremor or atrophy and the tongue muscle could move flexibly. The soft palate could lift powerfully, the uvula was in middle and the pharyngeal reflex was normal. She could raise her head up or turn her neck normally and the shrug ability was powerful. The left arm muscle power was 4 degrees, left hand grip force was 4 degrees, right arm muscle power was 3+ degrees and the right hand grip force was 4 degrees. Muscle power of the legs was 4+ degrees. There was obvious muscle atrophy of her finger interphalangeal muscles and thenar muscles. The 4 limbs muscle tone were normal, arm and leg tendon reflex cannot be induced. The bilateral ankle clonus was negative and the abdomen reflex could not be induced. The Palm-jaw reflex of both sides, sucking reflex, bilateral Hoffmann sign, Rossilimo sign of both sides and Babinski sign were all negative. Sensory examination was normal by gross measure. She could not perform the finger to nose  and fast alternate movement flexible tests because of weakness. Finger opposite movement was not good enough, she can perform the heel-knee-tibia test in a stable manner 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, nerve growth factors and neurotrophic factors), improve body environment (Edaravone and Riluzole ), regulate her immune system and improve blood circulation. This was combined with rehabilitation training.   

Post-treatment:
After 14 days treatment her headache symptoms were relieved, the choking symptoms showed some good change and she swallowed better. Her arm muscle power increased obviously with the arm abductor muscle power now being 5- degrees, the adductor muscle power 4+ degrees, the hands grip force 5- degrees and  she could lift her wrist with much more flexibility and power. The walking ability and movement endurance improved so she can now walk better and for longer.

 

 

 

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