Norah- Epilepsy-(Saudi Arabia)

Name: Norah
Sex: Female
Nationality: Saudi Arabian
Age: 1.5Y
Diagnosis: 1. Epilepsy, West syndrome  2. Sinus arrhythmia
Discharge Date: 2018/07/11

Before treatment:
The patient was a full-term normal delivery baby, her APGAR score was 9 when she was born. She was found to be weak in her crying and ABG showed she had compensated metabolic acidosis. She was taken to NICU where she was in low temperature air for treatment for 3 days. She had epilepsy after she was born for 11 hours. The doctor used Luminal for treatment but she still had epilepsy attacks. The brain CT result showed low-density change of brain white matter and intraventricular blockage. She was diagnosed with neonatal asphyxia and went home 37 days later. She was given medicines regularly but she still had attacks now and then. The EEG showed abnormal brain wave rhythm and she was diagnosed with West Syndrome. For now she has developmental problems in her motor functions and intelligence ability. She is unable to raise her head, crawl, sit up or turn over. She doesn’t know family members, she cries when she is hungry, she is unable to suck or chew, she doesn’t speak, smile or have a reaction to light.
Her spirit is normal, she sleeps 14-16 hours each day, she has a liquid diet of 100ml 6  times each day and she will be given 10ml of water many times each day. She has normal urination and defecation functions.

Admission PE:
Bp: 76/58mmHg, Hr: 101/min, breathing rate: 28/min, body temperature: 36 degrees. Height 74cm, weight 7Kg. Nutrition status is normal with normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht and no throat congestion. Chest development is normal, the respiratory sounds in both lungs were clear and there were no dry or moist rales. The heart beat is powerful with irregular cardiac rhythm and with no obvious murmur in the valves. The abdomen was soft and flat with no masses or tenderness.  Her liver and spleen were normal.

Nervous System Examination:
Patient was alert with no speech. She could not complete the examination of memory, orientation and calculation ability. Both pupils were equal in size and round, diameter of 3mm and the eyeballs can move freely. Her right eye response to light was mildly clumsy, left side had a weak reflex, she could not complete the eyesight, visual field and nystagmus tests. Bilateral forehead wrinkle and nasolabial fold are symmetrical, she could not complete the cranial nerve examination. The neck and back muscle powers were weak with poor head control ability and she could not sit up, roll over in bed or crawl. She could not do the 4 limbs muscle power examination, the 4 limbs muscle tone was basically normal. Tendon reflex of the 4 limbs were normal, sucking reflex was negative. Bilateral palm-jaw reflex was negative. The Hoffmann sign and Rossilimo sign of both sides could not be examined, the Babinski sign was positive. She could not complete the sensory examination and coordinate movement ability tests, the meningeal irritation sign was negative. 

After the admission she received 3 times nerve regeneration treatment(neural stem cells and mesenchymal stem cells) to repair her damaged nerves, activate and nourish nerves, regulate her immune system and improve blood circulation. This was done with rehabilitation training.     

After 16 days treatment her spasm attacks reduced, she had more smiling and occasionally had pronunciation of “a”. The patient condition is stable and her mental status is good.


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