Sajid Idris-Amyotrophic Lateral Sclerosis-(India)

Name: Sajid Idris 
Sex: Male
Nationality: Indian
Age: 43Y
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)
Discharge Date: 2018/08/05

Before treatment:
In August 2017 the patient felt weak in his left arm, he also had facsiculation and soon his left leg also became weak. He also had muscle atrophy. He did an  EMG in November and was diagnosed with ALS. 2 months ago he felt weak in his right side limbs and at present it is hard for him to turn over, get up, sit up or stand. His balance function is bad, he can walk a few meters with a walking aid. He is unable to take care of himself.
His spirit is good, his diet and sleep are normal. His urination and defecation functions are normal. 

Admission PE:
Bp: 133/93mmHg, Hr: 71/min, breathing rate: 18/min, body temperature: 36. degrees. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion and his tonsils do not have swelling. Chest development was normal, his chest movement range decreased when he was breathing, the respiratory sounds in both lungs were clear and there was 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, there was middle pitting edema of his legs below the ankle joints.

Nervous System Examination:
Patient was alert and had clear speech. His 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, no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical and he can close his eyes powerfully. He could make his tongue extend out normally, there was no tongue muscle tremor or atrophy and the tongue muscle could move in a flexible way. The soft palate could lift powerfully, the uvula was in middle and the  pharyngeal reflex was normal. He could lift his head up and turn his neck normally but the shrug ability was weak. The left arm adductor muscle power was 1 degree, abductor muscle power was 2+ degrees, the left hand grip force was 2 degrees, his left hand fingers can not stretch well, the fingers power was 2 degrees. The right arm adductor muscle power was 2+ degrees, the abductor muscle power was 3 degrees, the right hand grip force was 4- degrees, his right hand fingers could not stretch straight and the right hand finger power was 4 degrees. His left leg muscle power was 2- degrees, the right leg muscle power was 3+ degrees. There was obvious middle range muscle atrophy of his shoulder girdles, the biceps and triceps muscles and the finger interphalangeal muscles. The 4 limbs muscle tone were normal, right arm tendon reflex was normal, left arm tendon reflex was lower than normal. The leg tendon reflex was flexible. The bilateral side ankle clonus was negative, abdomen reflex could not be induced, the bilateral palm-jaw reflex was positive and the sucking reflex was positive. His bilateral Hoffmann and Rossilimo signs were negative and the Babinski sign of both sides was a doubtful positive. His sensory system examination was normal, he could not perform the finger to nose test and fast alternate movement in a stable manner, finger opposite movement was also not stable. He could not perform the heel-knee-tibia test because of weakness. 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, regulate his immune system and improve blood circulation. This was done with rehabilitation training.     

Post-treatment:
After 15 days treatment his left arm adductor muscle power was 2 degrees, he could bend the elbow joint better than before, he could lift his wrist sometimes and the left hand grip force was 2+ degrees. Right arm adductor muscle power was 3 degrees, abductor muscle power was 4 degrees, right hand grip force was 5- degrees. The left leg muscle power was 2 degrees, right leg muscle power was 4- degrees. The muscle spasms alleviated compared to before, he could walk longer with some help and his respiration function was better. The finger blood oxygen concentration was now maintained around 96-98%.