Tahani Abdullah Alnajjar-Motor Neuron Disease (MND), Type 2 Diabetes Mellitus-(Oman)

Patient Name: Tahani Abdullah Alnajjar
Gender: Female
Age: 52 years old
Nationality: Oman
Diagnosis: Motor Neuron Disease (MND), Type 2 Diabetes Mellitus

Condition at Admission:
The patient was admitted primarily due to "progressive weakness in all four limbs for over 3 years," diagnosed as "motor neuron disease." Approximately 3 years ago, the patient experienced weakness in her right hand without obvious cause, with limited finger function, which gradually progressed to weakness in both upper and lower limbs, accompanied by muscle atrophy. A local hospital diagnosed her with "motor neuron disease," and she was treated with "Riluzole," which was discontinued after proving ineffective, leading to continued disease progression. Currently, muscle strength in both upper limbs had decreased, with the right upper limb being significantly weaker; she struggled to touch her nose with her right hand in a semi-reclined position and could not lift her right upper arm off the bed while lying down. Her right hand fingers were almost unable to grasp, and both hands exhibited stiffness in joint movement. Muscle strength in both lower limbs was weakened, allowing her to stand and walk short distances with assistance. Muscle atrophy was noted in both upper limbs, and there were no significant swallowing difficulties or choking while drinking. The patient had a history of diabetes, managing her blood sugar with Aspart insulin (6 units before each meal) and Degludec insulin (14 units before bedtime).

Physical Examination on Admission:
The patient's pulse was 84 beats per minute, respiratory rate 20 breaths per minute, blood pressure 128/72 mmHg, and oxygen saturation 97%. Her lips showed no significant cyanosis. Breath sounds were clear in both lower lung fields, with no obvious dry or wet rales. Heart sounds were strong and rhythmic, with no murmurs noted in the valve areas. The abdomen was soft, and the liver and spleen were not palpable below the costal margin.

Neurological Examination:
The patient was alert and in good spirits. Her speech was clear. Cognitive functions, including calculation, memory, and orientation, were normal. Both pupils were 3 mm in diameter, with a brisk light response, and there were no restrictions in eye movements. Her nasolabial folds and forehead wrinkles were symmetrical, the tongue was midline without atrophy, and tongue movements were normal. Buccal pressure was adequate, and chewing strength was generally normal. Both sides of the soft palate elevated well, and she did not choke while drinking. Neck rotation and shoulder shrug strength were grade 4; proximal muscle strength in the left upper limb was grade 3, with grip strength in the left hand also 3, making it difficult to grasp a cup. The right upper limb proximal muscle strength was grade 2, with grip strength in the right hand grade 1, exhibiting stiffness and inability to bend. Joint movement in both hands was stiff. Lower limb strength was grade 3-; while lying down, the left lower limb could be lifted for 5 seconds, and the right lower limb for about 3 seconds, but both lower limbs could not be lifted simultaneously. There was stiffness in the toes and ankles of both feet, more pronounced on the left side. Sensation in all limbs was essentially normal. Muscle tone in both lower limbs was slightly elevated. Tendon reflexes in the limbs were diminished, with suspiciously positive pathological signs in both lower limbs. Signs of meningeal irritation were negative.

Treatment Process:
The patient was admitted with a clear diagnosis of "motor neuron disease and type 2 diabetes." During her hospitalization, she received treatment involving neural stem cells to repair motor neuron damage and mesenchymal stem cells for neurotrophic, endocrine, and immune support. Additionally, she was treated with drugs such as edaravone, riluzole, neurotrophic factors, and reduced glutathione as part of a CAST treatment regimen, along with comprehensive rehabilitation therapy.

Post-Treatment:
The patient's motor function shows significant improvement, and the progression of the disease is halted. She achieves near-normal strength grade 5 in neck rotation and shoulder elevation. Her left upper limb strength reaches grade 4, allowing her to grasp a cup and drink water. Her right upper limb strength is improved to grade 3+; while lying on her back, she can raise her arm approximately 30 centimeters, reach her head, and touch her eyebrows in a semi-reclining position. Her right hand grip strength is grade 3-, enabling her to grasp four fingers of another person and resist some degree of force. The flexibility and movement of her fingers significantly are improved. In her lower limbs, strength also reaches grade 4, and she is able to walk short distances independently (e.g., to the restroom). The stiffness in her lower limbs is decreased, and she can maintain a single-leg lift for 10 seconds, with both legs able to be raised simultaneously for 5 seconds while lying on her back. Overall, her energy levels, physical fitness, and exercise endurance all significantly are improved.