Mr.Leo-Parkinson Disease-(Israel)

Name: Mr.Leo
Sex: Male
Nationality: Israeli
Age: 66Y
Diagnosis: 1. Parkinson disease plus dementia  2. Postural hypotension     
Discharge Date: 2018/11/15

Before treatment:
The patient had micrographia and tremor 10 years ago. It was hard for him to write and as his condition got worse he showed slow movement. He was diagnosed with Parkinson's disease in a local hospital, took Azilect 1mg once a day, but his condition still got worse. 8 years ago he began to use Requip, 4 years ago he had balance problems and he needed help with daily life. In   recent years his condition got worse and he had illusion and persecutory delusion sometimes. At present he has muscle stiffness, slow movement,  is unable to walk, has less facial expression and more eye blinking. It is hard for him to write and he also has balance problems.
His diet is normal, sometimes he sleeps well but sometimes not and his defecation function is normal.

Admission PE:
Supine blood pressure: 122/78mmHg, standing blood pressure: 87/56mmHg, Hr: 76/min, breathing rate: 19/min. Height 164 cm, weight 71Kg. He has normal nutrition status, there were no yellow stained or bleeding points, there was skin damage post traumatic in his left knee around 3cm, the right anterior tibial skin was broken with a clean wound around 1.4cm. There was no pharyngeal hyperemia and no tonsil swelling. The respiratory sounds in both lungs were clear and there were no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was 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 slurred and fast speech with a weak voice. The memory and calculation abilities were poor, the orientation ability was normal. He had reduced facial expression and blinking with eyelid ptosis. Both pupils were equal in size and round, diameter was 3 mm, the reaction to light was sensitive and there was no nystagmus. His eyeballs can move normally. The bilateral forehead wrinkle and nasolabial fold are symmetrical, there was tongue muscle tremor, he had limitation in tongue muscle movement,  could make his tongue extend out to the lip on the side but he could not push against the cheek powerfully. The bilateral soft palate could not lift powerfully, the uvula was normal. His neck was rigid and he could turn his head slowly. The 4 limbs had slow movement with stiffness. The arm muscle power was 4 degrees, leg muscle power was 3+ degrees, he could not roll over in bed, get up, stand up or walk, etc. The arm muscle tone was normal, the leg muscle tone was increased. The right side abdomen reflex was normal, left side could not be induced, the bilateral biceps reflex, triceps reflex, radial periosteal reflex were normal, the patellar tendon reflex and Achilles tendon reflex were  reduced. The  bilateral Hoffmann sign was negative, the Rossilimo sign was positive. Sucking reflex was negative, the palm-jaw reflex of both sides were positive and the Babinski sign of both sides were positive by strength test. His sensory examinations were normal, the finger to nose test and finger opposite movement were less accurate or stable, the fast alternate movement was clumsy, especially the  right side. He could not perform the heel-knee-tibia test, the Romberg sign was positive and 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 (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 balance and motor functions were better, his facial expression was much more natural, he spoke louder and clearer, his tongue was more flexible and he could move his head faster. His leg rigidity alleviated and the limbs could move with much more flexibility. He could now move his hands better and he could do the finger to nose test easier. The muscle power in his legs was increased, the slow movement reduced obviously and he could now walk with a much more stable gait. He could sit up, stand up and walk on his own and was flexible in turning. His memory was better, he could remember what he ate in one day, he slept better and had less illusion. He could now do calculations better. His supine blood pressure was 120/80mmHg, standing blood pressure: 105/70mmHg.