Name: Hahne A Attia
Sex: Male
Nationality: American
Age: 55Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis (ALS)  2. Sleep Apnea
Discharge Date: 2019/07/13

Before treatment:
One year ago the patient developed muscle bundle tremor, woke up in the morning with bilateral leg spasm and then gradually decreased the strength of both legs which made it hard to walk. 8 months ago his right leg weakness significantly aggravated so he went to the local hospital for an  MRI that found L4 to 5 intervertebral disc herniation and it was considered the symptoms were caused by it. There was no improvement after an epidural injection. Discectomy was performed in January 2019 but there was no improvement after the operation and then an epidural injection (S1) was performed again in February 2019. Two months ago he was diagnosed as having amyotrophic lateral sclerosis. No treatment was given. At present the patient cannot walk independently so needs assisted walking, the whole body has muscle bundle tremor, respiratory monitoring shows that respiratory function is slightly damaged, arm movement, language and swallowing functions are not involved.
His spirit and sleep are normal. His urination and defecation functions are regular.

Admission PE:
Bp: 122/82mmHg, pulse rate: 80/min, breathing rate 19/min, body temperature: 36.3 degrees. The patient has good nutrition status and normal physical development. There is no ecchymosis of the skin or mucosa, no congestion of the throat, a symmetrical chest, clear respiratory sounds of both lungs, no dry or moist rales heard, regular heart sounds, regular heart rhythm, and no obvious murmur heard in the valves. He has a soft abdomen, no  rebound tenderness, normal liver and spleen, pitting edema of the bilateral ankles with chromatosis observed and arteriopalmus felt.

Nervous System Examination:
Patient was alert, has good spirit, fluent speech and with normal memory, calculation and  orientation abilities. Both pupils were round and equal in size with a diameter of 3 mm, reacting sensitively to light. There was free eyeball movement, no nystagmus, strong eye-closing, symmetrical forehead wrinkle and nasolabial fold. He has strong cheek puffing without air leakage, his tongue is in the middle when sticking out and it can reach slightly beyond the lips with muscle fibrillation. He can lift the soft palate, has strong neck-turning and shrug ability. Muscle power: bilateral arms 5; bilateral gripping power 5; right leg 1+; left leg 3-. Normal muscle tone of the 4 limbs, active tendon reflexes of the 4 limbs, negative Hoffmann sign, Rossilimo sign, and Babinski sign bilaterally. Normal deep and shallow sensation by gross examination, relatively sensitive fast alternating test, finger to nose test, and finger to finger test bilaterally. Bilateral heel-knee-tibia test cannot be done due to muscle power problems. Negative meningeal irritation sign.

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, nerve growth factors and neurotrophic factors), improve body environment (Edaravone and Riluzole ), regulate his immune system and improve blood circulation. This was combined  with rehabilitation training.   

Post-treatment:
After 14 days treatment his respiratory function got better and movement endurance increased. The muscle power in his legs increased 20%, he could raise his left leg higher and move faster, his exercise tolerance was improved. He could raise his right leg above the bed and could now move on the bed and walk longer.