Louis-Motor Neuron Disease(Malaysia)

Name: Louis
Sex: Male
Nationality: Malaysian
Age: 36Y
Diagnosis: Motor Neuron Disease(MND)      
Discharge Date: 2018/12/15

Before treatment:
The patient felt weak in his left knee in Feb. 2016, he fell down a lot and both of his legs became weak. 2 months later he went to a local hospital but was not diagnosed. 1 year later his arms became weak and he was unable to speak clearly so he went to hospital again and was diagnosed with MND. He took Riluzole and vitamins and also did rehabilitation training but his condition still got worse. 3 months ago he couldn’t walk, was unable to move his hands well, get up or stand.
His spirit is normal, his diet and sleep are normal, his urination and defecation functions are normal.

Admission PE:
Bp: 115/72mmHg, Hr: 77/min, breathing rate: 18/min, body temperature: 36.0 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, the respiratory sounds in lower lungs part were weak, 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 mild edema of the legs.

Nervous System Examination:
Patient was alert, had weak mental status and a slur in his speech. His memory, comprehension and calculation abilities were normal . Both pupils were equal in size and round, diameter of 2.5 mm, the reaction to light was sensitive, no nystagmus and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical, he can close his eyes powerfully, make his tongue extend out normally, there was tongue muscle atrophy and the tongue muscle could move in a  flexible manner. Showing teeth was normal, he could bulge his cheeks with air leakage, his chewing ability was normal and the soft palate could lift powerfully. There was middle muscle atrophy of his shoulder girdle muscle groups, triceps muscles, biceps muscles, intercostal muscles, latissimus dorsi, quadriceps femoris, biceps femoris muscle and gastrocnemius muscle. The neck was soft, his left side can turn or shrug weakly. The right arm proximal muscle power was 3 degrees, the distal side muscle power was 3+ degrees, the right hand grip force was 3 degrees. The left arm proximal side muscle power was 3 degrees, distal side muscle power was 4- degrees and the left hand grip force was 4- degrees. The leg muscle power was 3+ degrees and the 4 limbs muscle tone were normal with the ankle clonus  negative. Bilateral biceps reflex and radial periosteal reflex were normal, the leg patellar tendon reflex and Achilles tendon reflex were mildly active, the bilateral Palm-jaw reflex was positive,  Hoffmann sign, Rossilimo sign of both sides and the Babinski sign of both sides were all positive. The patient could not perform the finger to nose test because of weakness, finger opposite movement was bad and fast alternate movement was performed slowly. He could not perform the Heel-knee-tibia test also because of the low muscle power. 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, improvement body environment (Riluzole and edaravone), replace dead nerves, nourish nerves (Gangliosides, neurotrophic factors), regulate his immune system and improve blood circulation. This was combined with rehabilitation training.     

Post-treatment:
After 14 days treatment his breathing function got better, oxyhemoglobin saturation was 95-08%, he spoke clearer and louder, he could chew food easier and he could now could swallow easier so he ate faster. He could now  control his sitting or standing position in a much more stable manner and he could raise his arms easier. His grasp was more powerful, he could raise his legs higher and he could now walk better and longer.