Chai Yu Tony Wong-Amyotrophic Lateral Sclerosis-(Canada)

Name: Chai Yu Tony Wong
Sex: Male
Nationality: Canada
Age: 63Y
Diagnosis: Amyotrophic Lateral Sclerosis
Discharge Date: 2019/12/26

Before treatment:
The patient had no cause for left arm weakness in April 2018 and then this  developed in the left leg with left limb muscle atrophy. He went to the local hospital many times and underwent electromyography, MRI and other examinations. He was highly suspected as having motor neuron disease. No medication was taken. After the gradual accumulation of the right arm and right leg problems, accompanied by obvious muscle bundle tremor, he was admitted to the local hospital in October 2019. The relevant examination was performed to diagnose "amyotrophic lateral sclerosis". At present the patient needs  assistance with walking and can only walk a distance of 20 meters. He can complete activities such as sitting up and turning over on the bed alone. Muscle atrophy is found in biceps brachii, thenar muscles of both palms, interpalmar muscles and biceps femoris. Muscle bundle tremor of the left limb is more obvious than that of the right side. Drinking water causes slight choking, respiratory function is suppressed, dysphagia and dysarthria are not found.
He has poor spirit, bad sleep, needs the assistance of sleeping pills, has snoring, poor diet, no abnormal defecation or urination functions but with no significant increase or decrease in weight.

Admission PE:
Bp: 125/72mmHg, Hr: 84/min, breathing rate: 18/min. Nutrition status is good with normal physical development. There is no yellow stained of his skin, dry pharynx without hyperemia, there was no swelling in the tonsils, his chest movement range decreased when he was breathing, the respiratory sounds in the lower lungs part were weak and there was no dry or moist rales. Sat is 92-94%, the heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was bulge with no masses or tenderness, the liver and spleen were normal, there was no edema of the legs.

Nervous System Examination:
Patient was alert, has normal mental status, his speech was slightly affected,  memory, comprehension and calculation abilities were normal. Both pupils were equal in size and round, diameter of 3 mm, the reaction to light was sensitive with no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical, he can make his tongue extend out normally, the tongue muscle can move freely, showing teeth was normal and he could bulge his cheeks powerfully. Chewing ability was normal, soft palate can lift normally, the uvula turns to the left side. There was muscle atrophy of both shoulder girdles, the 4 limbs, thenar muscles and hands interosseus muscles. His neck was soft, his shrug and neck turning ability was weak. The  proximal side muscle power of the arms was 1 degree, right distal side muscle power was 2 degrees, the left side distal muscle power was 1 degree. His leg muscle power was 1 degree. The hands finger joints were rigid, he could not grasp and can only move his fingers slightly. The muscle tone of the 4 limbs were lower, right elbow joint cannot bend well, 4 limbs tendon reflex cannot be induced. His bilateral Babinski sign and Hoffmann signs were negative, he only can perform the right hand finger opposite movement with one finger, left side can not perform that movement. He could not perform the finger to nose test or fast alternate movement because of weakness. The heel-knee-tibia test cannot be performed, the meningeal irritation sign was negative.

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

Post-treatment:
After 14 days treatment, his respiration function improved, the blood oxygen saturation was around 95-98% with a  clearer respiration sound. The muscle power of upper limbs was increased 20%, he can raise arms easier, move shoulders easier, limbs' movement was flexible, grip force was increased. His hands did fine movement better. The muscle power increased 20%, he could walk by himself, he could walk 10 metres independent.