Name: Abdullah Qahas
Sex: Male
Nationality: Saudi Arabian
Age: 68Y
Diagnosis: 1.Amyotrophic Lateral Sclerosis(ALS) 2. Diabetes (type2)                                
Discharge Date: 2018/08/20

Before treatment:
The patient felt weak in his left arm 3 years ago and he was diagnosed with ALS. His condition got worse and worse so he went to Japan to do treatment 1 year ago. His condition was not improved, his four limbs all became weak and he was unable to take care of himself. He also did Edaravone injections for 10 days every month for a year. He was unable to speak clearly in 6 months. At present the motor function in his arms is bad, he can’t walk well and  it is easy for him to get tired.
He sleeps well and eats as normal. His urination and defecation functions are normal. He has had diabetes and hypertension for many years.

Admission PE:
Bp: 158/82mmHg, Hr: 86/min, breathing rate: 18/min, body temperature: 36.2 degrees. Height 162cm, weight 71.5Kg. 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 both lungs were clear, in the lower lungs part they were weak 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 with no edema of the legs

Nervous System Examination:
Patient was alert, had 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, with  no nystagmus  and the eyeballs can move freely. The bilateral forehead wrinkle and nasolabial fold are symmetrical and he can close his eyes powerfully. He could make his tongue extend out normally, there was no tongue muscle tremor or atrophy , the tongue muscle could move flexibly and the soft palate could not lift powerfully. He could turn his head and shrug powerfully. The right arm proximal side muscle power was 1 degree, distal side abductor muscle power was 4- degrees, the adductor muscle power was 3 degrees. Right hand grip force was 2 degrees. The left arm proximal side muscle power was 2- degrees, the distal side abductor muscle power was 4- degrees, adductor muscle power was 3- degrees, his hand could not turn outwards, the left hand grip force was 2- degrees. The leg muscle power was 3+ degrees and the 4 limbs muscle tone were basically normal. His arm tendon reflex was decreased, the leg tendon reflexes were active. Bilateral Hoffmann sign, Rossilimo sign and the Babinski sign of both sides were negative, his sensory examination was normal by gross measure. Patient could not perform the finger to nose test, the fast alternate movement and finger opposite movement because of weakness. The heel-knee-tibia test was basically normal 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, regulate his immune system and improve blood circulation. This was done with rehabilitation training.     

Post-treatment:
After 14 days treatment his motor functions became better, his left arm adductor muscle power was 2+ degrees, the distal muscle power was 4 degrees. The patient's hands can now turn outwards, the grip force was much better and the motion range of his left hand fingers was better than before. The motor functions in his legs became better, he could walk better, his finger tip oxygen concentration was now maintained around 96-98%, his blood pressure and blood sugar level were now controlled much better.