Colin Smith-Motor Neuron Disease-(Britain)

Name: Colin Smith
Sex: Male
Nationality: British
Age: 58Y
Diagnosis: Motor Neuron Disease
Discharge Date: 2019/03/05

Before treatment:
In January 2018 the patient had right foot droop and his walking was affected. Right leg weakness gradually appeared, his left leg also had weakness, and sometimes both leg muscles had spasms and pain, especially in the right leg. He was diagnosed with motor neuron disease in May 2018.He started taking riluzole 50mg twice a day and quinine 100mg once each night but his condition continued to progress, the weakness of both legs was aggravated and his walking and balance are involved. He broke his left shoulder in August 2018 due to unstable balance. In the past four months the patient needs help to sit up and stand, he cannot walk independently but he can walk 20 to 50 meters on the flat ground with a walker. There is no dysphagia, his speech is clear and there is no dyspnea.
His spirit is good, urination and defecation functions are normal, he needs medicines for sleeping and has had no significant weight loss.

Admission PE:
Bp: 126/86mmHg, Hr: 70/min, breathing rate: 18/min, body temperature: 36.5 degrees. Height 163cm, weight 75Kg. Nutrition status is good with normal physical development. There are no bleeding spots of his skin and mucosa, no blausucht, there is a left shoulder skin scar post surgery, no throat congestion, and his tonsils do not have swelling. Chest development was normal, his chest movement range was normal when he was breathing, 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 and no obvious murmur in the valves. The abdomen was flat and soft with no masses or tenderness. The liver and spleen were normal and there was mild edema of the legs.

Nervous System Examination:
Patient was alert, had clear speech, his memory, comprehension and calculation abilities were normal . Both pupils were equal in size and round with a diameter of 2.5 mm and the reaction to light was sensitive. His eyeballs can move freely and he could close his eyes powerfully. The bilateral forehead wrinkle and nasolabial fold are symmetrical, he could make his tongue extend out normally and his tongue can move freely. Showing teeth was normal, the soft palate could lift powerfully, his swallowing function was normal, his neck can move well and he could shrug powerfully. His right arm muscle power was 5 degrees, the left arm was 4+ degrees, the hands grip force was normal. The right leg muscle power was 2+ degrees, the left leg was 3 degrees. The muscle tone of his arms were normal, leg muscle tone was slightly high, especially the right side. The bilateral biceps reflex and triceps reflex were normal, patellar tendon reflex was active, his Achilles tendon reflex was normal, ankle clonus was negative. His left side abdominal reflex was normal, right side abdominal reflex cannot be induced. The bilateral palm-jaw reflex were negative and the sucking reflex was negative. The Hoffmann sign of both sides could not be induced and the Babinski sign of both sides were negative. His sensory system was normal by gross measure. The finger opposite movement, fast alternate movement and finger to nose test were normal. The bilateral heel-knee tibia test could be done slowly and the meningeal irritation sign was negative.

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

Post-treatment:
After 14 days treatment his appetite improved, edema in the legs is reduced, he can move  his legs better, the right forearm can move slightly and the right hand grip force improved to around 4- degrees. The left hand fingers can move with much more flexibilty, he can raise his legs easier, sit up easier and he now has primary walking ability.


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