Alsalamah Ayeshah-Familial progress myoclonic epilepsy-(Saudi Arabia)

Name: Alsalamah Ayeshah   
Sex: Female
Age: 59
Nationality:Saudi Arabia
Diagnoses: 1.Familial progress myoclonic epilepsy 2. Dysfunction of liver 3. Hypertension 2 level, high-risk group
Admission Date: 2014-10-23
Treatment time:21 days

Before treatment：
The patient suffered from myoclonic seizure with no obvious inducement when she was 17 years old. She suffered from tremor of whole body, this accompanied with nausea and vomiting. These symptoms lasted for about 5 minutes. The symptoms could be alleviated by itself, and didn't need emergency medications. She suffered intermittent attacks. So she went to a local hospital and was diagnosed with Familial progressive myoclonic epilepsy. She took Clonazepam tablets for treatment. Then the she suffered from epileptic seizure discontinuously. So she started using Depakine and Levetiracetam for treatment. There was no grand mal in recent 20 years. The patient suffered from tremor of four limbs, weakness of lower limbs. She was unable to stand or walk, only could crawl or used wheelchair.

Since the onset of disease, the patient had normal spirit. She was worried. The diet and sleep were almost normal. She has three brothers and a sister. They also suffered from similar disease. 
  
Admission PE: 
Bp: 137/70mmHg; Hr: 67/min. Br: 21/min. The skin and mucous membrane had no yellow stains. Thorax was symmetrical. The respiratory sounds in both lungs were clear, with no signs of dry or moist rales in lungs. The heart sound was strong and the heart rhythm was irregular. There was no obvious murmur in each valve. The abdomen was enlarged and soft. The liver and spleen were not palpable under the ribs. There was no edema in both lower limbs. Left lower limb couldn’t be straightened and the knee presented with 110 degrees.

Nervous System Examination: 
The patient was alert. Her speech was normal. The examination of memory, calculation, orientation and comprehension were normal. Both pupils were equal in size; the diameter of both eyes was 3.0mms. Both pupils reacted sensitively to light stimulus. Both eyeballs could move freely. The forehead wrinkle pattern was symmetrical; she had strong muscle to close eyes. The nasolabial sulcus was equal in depth. The tongue could be stretched normally. There was no atrophy in tongue. The teeth was showed without deflection. She could drum cheeks normally. She had strong muscle to lift soft palate. The pharyngeal reflex was normal. There was no cough when she drinks water. She could chew and swallow normally. The muscle strength to cough was strong. There was no dysarthria. The speech was normal. The neck had normal strength to support head. The muscle strength to shrug shoulders was strong. The muscle strength of both upper limbs was at level 5. The muscle strength of both lower limbs was at level 3. The muscle tone of four limbs was normal. The tendon reflex of both upper limbs was normal. The tendon reflex of both lower limbs disappeared. Bilateral abdominal reflexes were not elicited. Bilateral Hoffmann sign was negative. Bilateral sucking reflex was negative. Bilateral palm jaw reflex was positive. Bilateral Babinski sign was negative. The deep sensation, shallow sensation and subtle sensation were normal. She did finger-to-nose test, rapid rotation test and fingers coordination test in an unstable manner. She was unable to stand or walk. She was unable to compete with the examination of Rornberg. There was no meningeal irritation.

Treatment:
We gave Alsalamah Ayeshah a complete examination and she was diagnosed with 1.Familial progressive myoclonic epilepsy 2. Dysfunction of liver. She received treatment to improve the blood circulation in order to increase the blood supply and nourish the damaged neurons. She also received treatment to boost immunity, control tremor, reduce enzymes and protect liver. This was accompanied with daily physical rehabilitation training. 

Post treatment:
After admission, the patient's blood pressure is higher than normal for many times, the highest level reached 170/95mmHg. She was diagnosed with Hypertension 2 level, high-risk group. She received treatment to reduce the blood pressure. At present, the blood pressure is stable. After treatment, the transaminase has reduced to normal level. There is no obvious static tremor in four limbs. The intention tremor has reduced slightly.

 E-mail:

Date:2015-1-19

Dears

Hope you're all having a pleasant day. 

Please find the attached test results as per your request. Her heart rate and blood pressure are normal.

About her condition, I can notice a change in her shaking is less. She walks baby steps, which is a general improvement in her movement that we are so happy about.

Thank you so much for your cooperation. It's highly appreciated.