Kim Jegon-Multiple System Atrophy-(Korea)

The thrid round of treatment:
Name: Kim Jegon 
Sex: Male
Nationality: Korea
Age: 66Y
Diagnosis: 1. Multiple System Atrophy 2. High Blood Pressure Grade 2 (high risk) 3. Asthma
Discharge Date: 2019/12/04

Before treatment:
The patient developed unstable walking and dysphagia about 5 years ago and the condition worsened progressively. One year after the onset of the disease he was treated in the local hospital, was clearly diagnosed as having "multiple system atrophy" and was given oral drug treatment. The patient's condition continues to worsen. One year ago he came to our hospital for treatment. After treatment his language and balance function were better than before. After discharge the language function of the patient did not deteriorate but the decline of his balance function progressed slowly. Three months ago the disease progressed again with an accelerated decline in balance function and postural hypotension. At present his speech is not clear, the balance function is poor, the movements of sitting up, standing and walking are slow, the flexibility of fine movement of both hands is poor, it is difficult to write and he has frequency of urination at night.
His diet and sleep are normal, defecation function is normal and there are multiple urination actions at night. 

Admission PE:
Bp: 137/83mmHg in lying position and 105/70mmHg in standing position, heart rate: 78/min, breathing rate: 20/min, body temperature: 36 degrees, height: 162cm, weight: 78kg. The patient has unremarkable nutrition, no yellow stains or bleeding spots of the skin or mucosa, minor congestion of the pharynx, no swelling of tonsils, clear respiratory sounds of both lungs with no dry or moist rales heard. He has a strong heart sound, no murmur heard of various valves, a bulging abdomen, no tenderness or rebound tenderness, no masses, normal liver and spleen and no edema of the legs.

Nervous System Examination:
Patient was alert, had dysarthria, slurred speech with normal comprehension,  memory and  calculation abilities. He has equal and round pupils with a diameter of 3mm, reacting sensitively to light, free eyeball movement with minor nystagmus. With a symmetrical forehead wrinkle and nasolabial fold, tongue in the middle when extended, no tongue muscle atrophy, unremarkable tongue muscle movement, strong soft palate-lifting, uvula in the middle and strong neck-turning. There was grade 4 muscle power and normal muscle tone of the 4 limbs, he was slow sitting down, standing up and walking, has an unstable walking gait, wide walking base and slow body-turning. There was a decreased biceps reflex, triceps reflex, and radioperiosteal reflex, no knee tendon reflex and heel tendon reflex. He had a  negative Hoffmann sign, Rossilomo sign, and palm-jaw reflex bilaterally; negative Babinski sign bilaterally with normal superficial, deep and epicritic sensation. There was an unremarkable bilateral finger to finger test, unstable and inaccurate finger to nose test with the left side worse, clumsy fast alternate test with left worse; unstable bilateral heel-knee-tibia test and a positive Romberg's sign.  He could only stand on the left leg for 1-2 seconds; and was not be able to stand on his right leg,  could not walk in straight line and had a negative meningeal irritation sign.

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

Post-treatment:
After 10 days treatment he spoke clearer and better, had a better balance function,  walked better and moved faster. His hands were more flexible, he stood in a stable manner when his eyes were closed and maintained 8-10 seconds with single leg standing. He could turn over his body in two steps, his postural hypotension got better with the differential pressure in lying postion and standing position now less than 20mmHg.     

The second round of treatment:

Name: Kim Jegon
Sex: Male
Nationality: Korean
Age: 66Y
Diagnosis: Multiple System Atrophy，Respiratory Tract Infection
Discharge Date: 2019/05/02

Before treatment:
The patient developed walking instability and swallowing speech dysfunction about 4 years ago. One year later he was diagnosed in the local hospital as having " Multiple System Atrophy.” He was given oral medication but his condition continued to worsen. Six months ago the patient came to our hospital for treatment and his function of language and balance improved after treatment. After discharge the language function of the patient did not decline but the balance function decreased slowly. The decline rate of his balance function increased 2 months ago. At present his speech is not clear, the balance function is poor, he has frequency of urination at night being about once every 2 hours and his defecation function is out of control.
He has regular diet and sleep. A week before admission he had coughing and expectoration. The local hospital diagnosed him with a "respiratory tract infection" and was treated with amoxicillin. His cough is better after 7 days using the medicine but there is still some coughing and a small amount of yellow sputum.

Admission PE:
Bp: 150/89mmHg, Hr: 62/min, breathing rate: 22/min, body temperature: 36.0 degrees. His height is 162 cm, weight 82.5Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, there was throat congestion but his tonsils do not have swelling. 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 bulging and soft with no masses or tenderness. The liver and spleen were normal and there was no edema of the legs.

Nervous System Examination:
Patient was alert, had dysarthria and slurred 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, his eyeballs can move freely and there was mild horizontal nystagmus. The bilateral forehead wrinkle and nasolabial fold are symmetrical, he could make his tongue extend out normally, there was no tongue muscle tremor and the tongue muscle movement is ok. The soft palate could lift powerfully, the uvula was in middle and he could turn his neck powerfully. The 4 limbs muscle power was 5- degrees, the 4 limbs muscle tone was normal. Patient could sit up or walk slowly but had a mildly unstable gait when walking. He walked slowly with a wide step space and he could turn around slowly. The bilateral biceps reflex, triceps reflex and radial periosteal reflex were decreased. The patellar tendon reflex and Achilles tendon reflex could not be induced by examination. The bilateral Hoffmann sign and Rossolimo sign were negative, the palm-jaw reflex of both sides were negative, right Babinski sign was positive, left Babinski sign was negative. His sensory system examinations were normal. Bilateral finger to finger movement could be finished, bilateral finger to nose movement was not stable with the right side worse. The bilateral fast alternate movement was clumsy with left side worse. Bilateral heel-knee-tibia was not stable. The Romberg's sign was positive. He could stand on his left leg only for 2-3 seconds and could not stand on his right leg at all. He could not walk in a straight line. 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, improve body environment, regulate his immune system and improve blood circulation. This was combined with rehabilitation training.   

Post-treatment:
After 14 days treatment his balance function was better than before, his walking position was better, his 4 limbs coordination was better and the bilateral finger to nose movement and fast alternate movement were more flexible. He was more stable when standing with his eyes closed and he  could now stand on one leg for 8-10 seconds.

The frist round of treatment:
Diagnosis: 1. Multiple System Atrophy(MSA) 2. Benign focal amyotrophy
Discharge Date: 2018/10/14

Before treatment:
The patient couldn’t walk well 3 years ago, he had swallowing and language problems and was diagnosed with MSA by a local hospital 2 years ago. He used some oral medicines but his condition still got worse. For now, he is unable to speak clearly, his swallowing function is bad, he has frequent urination at night and he can’t control his defecation function well. His diet and sleep are normal.

Admission PE:
Bp: 150/90mmHg, Hr: 68/min, breathing rate: 19/min, body temperature: 36.4 degrees. His height is 162 cm, weight 80Kg. 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. 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 bulging and soft with no masses or tenderness. The liver and spleen were normal and there was no edema of the legs

Nervous System Examination:
Patient was alert, had dysarthria with slurred speech. His memory,  comprehension and calculation abilities were normal. Both pupils were equal in size and round, diameter of 3 mm and the reaction to light was sensitive. The eyeballs can move freely and there was  mild horizontal nystagmus. The bilateral forehead wrinkle and nasolabial fold are symmetrical, he could make his tongue extend out normally, there was no tongue muscle tremor and the tongue muscle could not move with flexibility. The soft palate could lift powerfully, the uvula tended to right side and he could turn his neck powerfully. The 4 limbs muscle power was 5- degrees, the 4 limbs muscle tone were normal. He could sit up or walk slowly with a mildly unstable gait when he walked, He walked slowly with wide a step space and he could turn around slowly. The bilateral biceps reflex, triceps reflex, radial periosteal reflex decreased, the patellar tendon reflex and Achilles tendon reflex could not be induced by examination. The bilateral Hoffmann sign and Rossilimo sign were negative, the palm-jaw reflex of both sides were negative, bilateral Babinski sign was positive. His sensory system examinations were normal. The right hand finger opposite movement was clumsy, the last three fingers could not stretch straight, left side finger opposite movement was done slowly, finger to nose test was not stable or accurate. The bilateral fast alternate movement was clumsy, the heel-knee-tibia test was not stable and the Romberg's sign was positive. He could stand with one leg for only 5-6 seconds and he could not walk straight. The meningeal irritation sign was negative.

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

Post-treatment:
After 14 days treatment his language function and balance function were better than before, his pronunciation was clearer, the flexibility of finger to nose and rapid rotation test of both arms was improved. The stability of the body improved when standing with closed eyes, he stood on one leg for 8-10 seconds and he now urinates less at night.