Noor Muhammad-Amyotrophic Lateral Sclerosis-(Pakistan)

Name: Noor Muhammad
Sex: Male
Nationality: Pakistani
Age: 67Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis, ALS 2. Diabetes (type 2)

Before treatment:
15 months ago the patient was unable to lift objects with his right hand so he went to a local hospital and did an EMG test. He was diagnosed with ALS and began to take Riluzole. After that his left arm became weak, then 2 months ago he felt pain in his neck. 25 days ago he had language problems. His tone was lower than before and his articulation was less than before. 15 days ago he had difficulty breathing, especially when he was tired or in the right lateral position. At present he cannot move his arms well but his legs are basically normal. As well, he is experiencing breathing and speech disorders so for further treatment he came to our hospital.
His spirit and sleep are good but he has poor diet. His urination function is normal, he needs to take pills for defecation.

Admission PE:
Bp: 130/77mmHg, Hr: 86/min, breathing rate: 20/min, body temperature: 36.2 degrees. Height 173 cm, weight 70 Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht and no tonsil swelling. The chest development is normal, the respiratory sounds in both lungs were weak, there was no obvious dry or moist rales. Fingertip saturation oxygen is around 90-95%. The heart beat is powerful with regular cardiac rhythm and with no obvious murmur in the valves. The abdomen was flat with no masses or tenderness. The liver and spleen were normal, shifting dullness is negative. The spinal column is normal and there was no edema in the legs.

Nervous System Examination:
Patient was alert and his mental status is good with clear speech. His memory, orientation and calculation ability were normal. Both pupils were equal in size and round, diameter of 3mm, react well to light and the eyeballs can move freely. There is no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical. Showing of the teeth is normal, his tongue is in the middle and shows no tongue muscle atrophy. The tongue can touch the cheek powerfully, he can bulge the cheek powerfully, chewing ability is good and the soft palate can lift as normal. He can close eyes powerfully. There is obvious muscle atrophy of the right shoulder muscle group, neck was soft and the ability to turn the neck was weak. He can shrug as normal. The left arm proximal side muscle power was 3 degrees, distal side was 4 degrees and grip force of left hand was 4 degrees.  The right arm proximal side muscle power was 1 degree, distal extensor muscle power was 4- degrees, flexor muscle power was 4 degrees, the grip force of right hand was 3+ degrees. Muscle power of the legs was 4- degrees and muscle tone of all 4 limbs was basically normal. The ankle clonus was negative. Bilateral biceps reflex and radial periosteal reflex cannot be induced. The patellar tendon reflex and tendon reflex in the legs cannot be induced The bilateral palm-jerk reflex, the Hoffman sign of both sides, the Rossilimo sign and Babinski sign are a doubtful positive. He cannot perform the left side finger to nose test well because of the muscle limitation. He can perform the finger opposite movement and can complete the fast alternative movement slowly. He cannot perform the right side finger to nose test because of the weakness and he cannot perform the finger opposite test. The fast alternative movement was performed slowly. The bilateral heel-knee-tibia test was basically normal, the meningeal irritation sign is negative.

Treatment:
After the admission he received related examinations and was diagnosed with ALS. He received 4 times nerve regeneration treatment  to repair his damaged nerves, replace dead nerves, nourish nerves, regulate his immune system and improve blood circulation. This was done along with rehabilitation training.     

Post-treatment:
After 20 days treatment the patient has better motor functions and his respiration function is better and clearer. The blood oxygen saturation is 93-97%. He could speak clearly, his distal arm movement ability shows good improvement, the grip force of both hands increased nearly 1 degree. Left hand grip force is now 4+ degrees and right hand is 4 degrees. The muscle power of the legs is 4+ degrees. He is able to walk longer distances.