Steven Zembroski-Amyotrophic Lateral Sclerosis-(USA)

Name: Steven Zembroski 
Sex: Male
Nationality: USA
Age: 56Y
Diagnosis: Amyotrophic Lateral Sclerosis
Discharge Date: 2019/05/29

Before treatment:
Eight months ago the patient had no obvious inducement to have right foot medial muscle spasm, right foot drop, back flexion weakness and walking difficulty so he began to use a foot and ankle brace to assist walking. After the gradual progress of the disease his right leg and hip muscles also appeared to have weakness. He did rehabilitation training but the condition did not improve. There was no definite diagnosis when he went to the hospital for an examination. He felt whole body muscle tension when he woke up, the arm and shoulder had obvious muscle tremor and he needed to take "baclofen" to relax. Since then he has had arm muscle tension, muscle spasm and the muscle tremor gradually increased with obvious weakness. 2 months ago he went to the hospital for an examination and he got a clear diagnosis of "amyotrophic lateral sclerosis." He began to do rehabilitation training and take oral administering of all kinds of health care drugs but the condition developed gradually. At present he needs to use aids to walk, both lower extremities and his right arm often appear to have muscle spasms and stiffness along with muscle tremor.
His spirit, sleep, diet, urination and defecation functions are normal.  

Admission PE:
Bp: 121/79mmHg, Hr: 60/min, breathing rate 18/min. Height 178cm, weight 82kg, body temperature: 36.2 degrees. He has good nutrition status and normal physical development. There was no cyanosis around the lips, a symmetrical chest, reduced breathing activity, normal respiratory sounds of the lower lung bilaterally and no dry or moist rales were heard. There was no  bulge in the precordia, strong heart sounds, regular heart rhythm and no obvious murmur heard in the valves. The abdomen is flat with no tenderness and masses, a normal liver and spleen, negative shifting dullness, normal spinal column, no edema of the legs and good dorsal artery pulse of the feet.

Nervous System Examination:
The patient was alert, had good spirit, clear speech, normal memory and orientation but reduced calculation ability. Both pupils were round and equal in size with a diameter of 3 mm, reacting sensitively to light and there was free eyeball movement. He had a symmetrical forehead wrinkle and nasolabial fold. The tongue extends out in middle, has flexible muscle movement, there was no air leakage with cheek-bulging, normal chewing, no choking when drinking, good lifting of the soft palate bilaterally and the uvula is in the middle. The neck was soft with normal neck-turning and shrug ability. There was muscle atrophy around the bilateral knees and ankles.  Muscle power: proximal and distal sides of the right arm was  5- and 5 respectively. The left arm bilateral gripping power was 5; right leg muscle power 4-, the left leg was 4. The right foot had obvious weakness of plantar flexion and weak dorsal flexion. The left foot had almost normal plantar and dorsal flexion. There was normal muscle tone of all 4 limbs. There was active tendon reflex of the right side limbs, hyperactive tendon reflex of the left limbs, positive ankle clonus on the right leg, negative ankle clonus of the left. Hoffmann sign and Rossolino sign of the right side were positive with a negative Hoffmann sign and Rossolimo sign of left side. There was a positive Babinski sign bilaterally, normal finger to finger, finger to nose and heel-knee-tibia tests, clumsy fast alternate movement of the right side and normal fast alternate movement of the left side.

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 the fasciculation reduced, there was more muscle power of the right arm proximal side, larger plantar flexion of the right foot and better foot lifting when walking. His limbs were more flexible, he can now walk better and his exercise tolerance was improved.