The second round treatment:

Name: Micaela Nahir Favio Forlese
Sex: Female
Country: Argentina
Age: 9 years
Diagnosis: 1. Chronic Encephalopathy 2. West Syndrome 3. Sinus Irregularity
Date of Admission: May 7, 2015
Treatment Hospital/Period: Wu Medical Center/27 days

Before treatment:
The patient had epilepsy 8 years ago without any reason at the age of 10 months. She couldn’t move her right side so she was send to hospital and diagnosed as” 1. west syndrome 2. chronic encephalopathy”. The was treated and the disease was under control and the patient did not have epileptic attack in the recent 5 years. The patient had mental retardation accompanied with aphasis and dyscinesia. She came to our center for treatment, and at the tme she was discharged, her head and trunk had more power. she could turn over in recumbent position. Her movements were flexible, she could control her head better than before and she could sit up with the support of sofa for 15 minutes. Her cognitive function had improvement. She could focus more when she stared at something and the duration was longer. She could say simple words like”yes” and she could understand simple sentence and had facial reaction. She could raise her head, turn over her head and sit for 1-2 minutes. She could turn over her body by herself, but she couldn’t sit up, stand or walk. Her family wanted a better treatment so she came to our hospital and diagnosed as” 1. west syndrome 2. chronic encephalopathy”.

She was in good spirit. Her diet was good. She could sleep well and her urination and defecation were normal.

Admission PE:
Temperature: 36.5℃, Bp: 111/70mmHg; Hr: 88/min, Br: 20/min. Height: 130cm, weight: 21kg. Development delay. The nutrition was bad. There was no yellow stain or petechia on skin and mucous membrane. There was no hyperemia in the oral pharynx. The tonsil was not enlarged. Symmetrical thorax. The respiration in both lungs was clear, there were no dry or moist rales. The heart sounds were strong, she had arrhythmia. The rhythms of heart were regular and there was no obvious pathological murmur. She had abdominal retraction and the abdomen was soft. The liver and spleen were normal.

Nervous System Examination:
Micaela Nahir Favio Forlese was alert and good spirit. She could say “yes”. She could understand simple sentence and answer with expressions. She couldn’t cooperate with the memory, calculation ability, or orientation examinations. Both pupils were equal in size and round, the diameter was about 4.0mms. Both pupils were not sensitive to light reflex. Both eyes could follow moving objects. The ocular muscle was discordant. She couldn’t control her neck very well. The eyeballs would often experience abduction and adduction at the same time. She couldn’t cooperate with other cranial nerve examination. The swallowing ability was normal. She ate food normally. There was no cough with swallow. The neck was soft and weak. She could swivel and raise her head in horizontal position. Four limbs had activity. She could turn over by herself, but she couldn’t sit up or stand. She could only sit up with someone’s help for 1-2 minutes. She could walk when parents hold her. Both hands could raise and grasp. Her left side could move better than right. The grip of left hand was at level 3+, right hand was at level 3. Her lower limbs could move freely. She could do extension and flexion movement on the bed. The muscle power of both lower limbs was at level 1-2. The muscle tension of four limbs were normal. She has flat feet, both lower limbs were abnormal, the angle was 140 degrees at most. The tendon reflex was normal. The patella tendon reflex was over active. The ankle reflex was positive. The abdominal reflex was normal. The bilateral sucking reflex was negative. The Babinski sign was negative. The palm jaw reflex was positive. There were no signs of meningeal irritation.

Treatment:
Micaela Nahir Favio Forlese received a complete examination and she was diagnosed with 1. Chronic Encephalopathy and 2. WEST Syndrome. She received treatment to fix the damaged nerves, regenerate new nerves, activate the stem cells in her body, nourish the neurons, regulate her immune system, improve the blood circulation and control epilepsy. She also received treatment to reinforce nutrition. This was accompanied with rehabilitation training.

Post-treatment:
The patient’s weight: 22 kg. The cognitive function improved. Her comprehension was better, she could have facial expression to her likes. She could say more words especially ”baba”, ”mama” and ”yes”. The muscle strength of the head and trunk were stronger than before. The movement range of four limbs was wider. The angle of both lower limbs was 160 degrees. She could control her body better than before. The grip of both hands was at level 3-4, the muscle power of lower limbs was at level 2+. The sitting duration has increased.

The first round treatment:

Name: Micaela Nahir Favio Forlese

Sex: Female

Country: Argentina

Age: 5

Diagnoses: 1. Chronic encephalopathy 2. WEST Syndrome

Admission Date: October 11, 2012

Days Admitted to Hospital: 30 days

Before treatment:

About 5 years ago, when the patient was 10 months, she suffered from epileptic seizures without obvious cause. Her right limbs couldn't move. She was sent to hospital and was diagnosed with WEST Syndrome and Chronic encephalopathy. After antiepileptic therapy, the epileptic seizures were under control. But the patient��s intellectual development was slow. Before the treatment, the patient only could say "daddy" "Mum" and "Yes". Most of her language was e-ye language. She couldn't turn over, sit, stand or walk. She took antiepileptic drugs for 2 years and had no epileptic seizure.

Nervous System Examination:

Weight: 111cm, height: 18.5Kg. Micaela Nahir Favio Forlese was alert and she had "e-ya" speech. She could understand simple sentences and answer "Yes" or "No". She could say "daday" and "mama". Inattention. She couldn't cooperate with the memory, calculation ability, or orientation examinations. Both pupils were equal in size and round, the diameter was about 4.0mms. Both pupils were sensitive to light reflex. Both eyes couldn't follow the moved objects. The ocular muscle was discordant. The eyeballs often showed abduction position. She couldn't cooperate with other cranial nerve examinations. There was no cough when swallowing. The neck was soft and weak. The muscle tone was low. She could swivel and raise head in horizontal position. Four limbs had activity. She couldn't turn over, sit up, stand or walk. With some assistance, she lowered her head in sitting position. The muscle tone of four limbs was almost normal. Her feet were flat. The tendon reflexes of all four limbs were normal. The abdominal reflex was normal. The bilateral sucking reflex was negative. The Babinski sign was negative. She couldn't cooperate with the sensation and coordinated movement examinations.

Treatment:

Micaela Nahir Favio Forlese received a complete examination and she was diagnosed with 1. Chronic encephalopathy 2. WEST Syndrome. She received treatment to nourish the neurons, improve the blood circulation, improve nutrition and control the epilepsy. She also received treatment to nerve repair and nerve regeneration. This was accompanied with rehabilitation training.

Post-treatment:

The patient's gain some weight and the height has increased. Weight: 20Kg (increased 1.5 kg), Height: 113cm (increased 2 cm). The cognitive function has improved. Her ability to focus attention and stare at an object for a longer time is much better than before. Her intelligence ability had improved and can understand more language. She has more active language. The muscle strength of her head and trunk have increased more than before. She can turn over in clinostatasm. The action is more flexible. She has better control of her head. She can maintain the sitting position if she has back and head support. And the longest time she could maintain the sitting position was 15 minutes.

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E-mail:

2012-12-06

Hello, how are you? Here I am sending the blood test in Spanish, as they do in English .....

I wanted to say that Micaela pays more attention to the games or exercises that professionals will propose to her. She improved the eye tracking when making objects and she holds her head better.

Regards

karina y Lito

2013-01-13

Dr Wang:

Here I am sending the new blood test Micaela ....

She is currently taking the medication they gave us at the clinic and is still taking Levetiracetam (500 mg) 2 pills a day and valproic acid: 5ml at night and 4 ml of tomorrow.

She greatly improved her vision, she improved her cognitive area, we can see that she understands much better the orders that are given to it, with the motor area, she moves her right arm much. On her legs did not see more changes than it had there in the clinic of Dr. Wu.

Now in February, Micaela´s doctor will do a botulinum toxin (BOTOX) in your legs in adductor muscle in gracilis muscle and hamstring ... this is to help the muscle hypertonia she has.

The neurologist of Micaela recommended to discontinue the medication KETOTIFEN us, because our climate is different and she believes that Argentina does not need this medication. It can give only 1 time per day?

We wanted to know if we have to continue the same medication that you gave us in the clinic, it's been two months since we returned to Argentina and we brought medicines for three months .....

We await your prompt response

many Thanks

Karina and Lito and Micaela

2013/1/21

Micaela's mother email to us:

Mica is very well she has better your vision, she moves her right hand and is much larger and mature ...

Best Regards.... we miss them all

Micaela Favio

2013-02-26

Hello Dr Wang!

I tell you that Micaela is better .... her vision has improved, better holding his head, the legs have more strength but still she can not sit up alone or maintain balance to stand or walk.

Micaela better understand the words and babbles more but she still can not speak or be understood ....

Micaela has a good appetite, she eats the portion of food as an adult.

Micaela weighs 22 kilograms and her height is 120 centimeters.

She cries at night again and their intestines make noise ......

She continues to take the medication at the clinic and valproic acid 5ml at night, and 4 ml in the morning and 1 tablet of Levetiracetam 500mg every 12 hours.

I wanted to know if progress is fine according to treatment and if we have to redo the treatment in a time or should we expect more Micaela evolve.

I await your prompt response.

Best Regards

Karina-

Date: 2013-10-24

Hello !

I send the last blood test , this in Spanish

I tell you that Mica is very well .... it measures 1.28 m tall , weighs 24 kilograms

She better keep your head , you can sit alone for a few minutes and eat good food

thanks youvery much

Best regards

Karina y Lito

Date: 2014-02-24

Hello!
How are you? Us very well ....

Mica is still much progress yet, she eats well, her weight is 24.5 kilos, height 1.30 meters, she has better cognitive response, she has better head control, she does not speak yet, but trying to say words.
The attending physician she applied BOTOX on her legs

We wanted to know if Mica must continue taking the medicine that was given at the clinic ...... she is taking actualment respiridone, fluranizine, donepezil, oryzanol, levetiracetam and valproic acid and vitamin B12

Thank very much
kisses

Kari y Lito

 Date: 2015-9-24

Here I sent the blood test Micaela
She is much better, she remains seated itself more time, she tries to say her words and greatly improved cognitively
The weight of it remains the same between 24 and 24,500 kg
I wanted to know if continuing adequate medication you are taking?
And if she should take something to increase the value of vitamin D
I need if you can send me Oryzanol for the next 6 months .... There are some family clinic Argentina right now what can I bring?

Micaela´s Blood Test: 11/09/2015
CBC - result - reference value
8,900 leukocytes / mm3 (5000-10000)
5,020,000 red cells / mm3 (4.5 to 5.5 million)
13.5 gr% hemoglobin (12.18)
Hematocrit 40.2% (37-47)
197,000 platelets / mm 3 (150000-450000)

Difeencial count:
41% segmented neutrophils
3% eosinophils
Basophils 0%
52% lymphocytes
Monocytes 4%
V.C.M 80 fl (80-100)
H.C.M 26.9 pg (26-32)
33.6g C.H.C.M% (31-36)

Full hepatograma
Total bilirubin 0.5 mg% (up 0.9)
Direct bilirubin 0.1 mg% (up 0.2)
Indirect bilirubin 0.4mg% (up 0.7)
TGO 26 U / l (up to 40)
TGP 13U / l (up to 43)
Alkaline phosphatase 464U / l (up to 645)
Proteins 7.5gr% (6.1 to 8.3)
4.5gr% albumin (3.5 to 4.9)

TOTAL CHOLESTEROL 221mg% (up to 200mg%)
GLUCEMIA 90 mg% (70-110 mg)
UREMIA 50mg% (17 to 50 mg%)
ESR 6mm (up to 15)
Thyrotropin (TSH) uU 3.76 l / ml
Thyroxine (T4) 8.6 ug / dl
Triiodothyronine (T3) 1.19 ng / ml
ACID PLASMA VALPROIC 45.4 ug /ml (50- 100)
Vitamin D  13 ng/ml ( 30 a 50)

Thank you very much!

 Date: 2015-11-2

Dr Hello!
I am sending the new blood test Mica
Vitamin D is increasing, we still Mica medicating with vitamin D.

Mica medical neurology change in medication made her ....
Now she is with
- 1/2 levetiracetam tablet (250mg) in the morning and 1 tablet of levetiracetam (500mg) at night
- 4ml Ac. valproic morning and 4 ml of Ac. valproic night
- 1/2 tablet of oxcarbazepine (150 mg) in the morning and 1/2 tablet of oxcarbazepine (150mg) at night
and drugs clinic
Mica medical neurology changed medication because epilepsy it is more focused than before

Mica gained weight 2kg .... she eats well .. but still with sleep disorders.
she is starting to say a few words now and then .... like hello and daddy.

We are very satisfied with the results of Mica .... although their legs need further

Kisses from Argentina

Karina y Lito