Suad Hameed Salah Al-dahan-Motor Neuron Disease-(Iraq)-Updated on April 7, 2016

Author Zhangqi Views Posted at 2015/07/14

The First round treatment

Before treatment:
The patient could not speak clearly 1 year ago without any reason, and the disease became worse. She had difficult to chew and swallow 6 months ago and had weakness of her four limbs, accompanied with muscular atrophy. She could walk with stick. She was diagnosed as Motor Neuron Disease. She took Riluzole, but the disease was not brought under control. Her condition became worse, she couldn’t speak, chew or swallow. She could only eat liquid diet. Her limbs became weaker, and her muscular atrophy was worse. The muscle power of upper limbs was weak, but she could move her upper limbs. She easily get tired. Her lower limbs was weaker. She couldn’t walk 1 month ago. She wanted a better life, so she came to our medical center.

The patient was anxious, she had poor sleep and diet. Her urination and defecation were normal. And she lost about 40 pounds.

Admission PE:
Bp: 137/70mmHg; Hr: 99/min. Br:20/min. Temperature: 36.7 degrees. She is thin. Her body type was good. There was no yellow stains on skin and mucosa. Her pharyngeal was not congested. The tonsil was not enlarged. The range of motion of thorax was reduced. The respiratory sounds in both lungs were weak, there was no obvious moist or dry rales. The heart sounds was strong, the rhythm of her heartbeat was normal. There was no obvious murmur in the valves. The abdomen was soft with no pressing pain or rebound tenderness. Her liver and spleen were normal. There was pitting edema on right foot and ankle. Oxygen saturation was 90-93%.

Nervous System Examination:
Suad Hameed Salah Al-dahan was alert, she couldn’t speak. She could only say “ah”. She always shows anxiety. Her memory, calculation and orientation abilities were normal. Both pupils were equal in size and round, the diameter was 3 mms. Both eyes had sensitive response to light stimuli. Both eyeballs could move freely. The forehead wrinkle pattern was symmetrical. The ability to close her eyes was a little weaker. Both nasolabials were equal in depth. She couldn’t put out her tongue or show her teeth. The muscles of tongue was depauperated. The movement of tongue was inflexible. The soft palates could be lifted, and the strength was weak. The uvula was in the center of oral. Her pharyngeal reflex was weak, she couldn’t do cheek blowing. The muscle of neck was soft, the muscle strength to turn around and shrug shoulders were weak. The muscle power of both upper limbs was at level 3, the grip was at level 4. The muscle power of left lower limb was at level 3, right lower limb was at level 0-1. The muscle tension of both upper limbs was lower than normal, both lower limbs was normal. The ankle reflex and knee reflex were abnormal. The muscle between fingers, thenar and hypothenar eminences, both upper limbs, supraspinatus, infraspinatus and both lower limbs were seriously depauperated. The abdominal reflex was abnormal. Both side sucking reflex was positive, both sides Hoffmann sign, Rossilim and Babinski were all negative. The rough depth determination of both sides were normal, the finger-nose test, rapid rotation test were normal. Left side heel-knee-tibia test was good, but she couldn’t do the right side heel-knee-tibia test. The meningeal irritation sign was negative.

Treatment:
The patient was diagnosed as 1. Motor Neuron Disease 2. Hypertension. She received treatment to improve circulation, nourish neurons, fix her nerves function, and protect organs. We also gave her daily physical rehabilitation.

Post-treatment:
The patient’s condition was stable. She had more muscle power. Her swallowing function was better than before. Pharyngeal reflex was better. She could put her tongue against teeth. Her tongue movement was better. She could eat more. The respiratory function was better. The sound of middle and inferior part were clear. Oxygen saturation was 95-98%.The muscle power of both upper limbs was better, both upper limbs was at level 4, both hands’ grip was at level 5-, the muscle power of left lower limb was at level 3+, right lower limb was at level 2. Her emotion was stable.

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The second round treatment:

Name: Suad Hameed Salah Al-dahan
Sex: Female
Nationality: Iraqi
Age: 69 Years
Diagnoses: 1. Motor Neuron Disease(MND) 2. Hypertension 3. Right Collum Femoris Fractured (postoperative)
Date of Admission: Feb.5, 2016
Treatment hospital/period: Wu Medical Center/14 days

Before treatment:
Suad was not able to speak clearly 18 months ago, it became worse over time and the cause was not known. It was difficult for her to chew and swallow 1 year ago, and then she felt weakness and muscular atrophy developed in all four limbs. Suad had to use a cane to walk. She was diagnosed with Motor Neuron Disease (MND) at the local hospital. She took Riluzole with little improvement, and her condition only got worse until she couldn’t speak or make any audible sounds at all. Suad could only eat a liquid diet because of her difficulty with chewing and swallowing. The weakness and muscular atrophy in the four limbs became worse, she was still able to move her arms but she lost the ability to walk six months ago. Suad wanted a better quality of life so she came to our medical center and was diagnosed with Motor Neuron Disease (MND).

When Suad was first admitted to our hospital, she continually felt upset, she didn’t have a normal sleep routine, her diet was not good, and she had problems with urination and bowel movements. She had lost 40 pounds at the time.

Admission PE:
Bp: 126/86mmHg; Hr: 99/min. Br: 22/min. Temperature: 36.0 degrees. Oxygen saturation: 95%. Suad’s body type was normal but she was thin. There was a red depression in the middle of the sacroiliac, around 10cm*6cm with no ulceration. There were no yellow stains or petechia on the skin or mucous. There was no pharyngeal congestion. The tonsils were not enlarged. When Suad breathes, the expansion of the lungs is weak. There was no respiration in the base of the lungs. There were no dry or moist rales. The rhythm of the heartbeat was normal and strong. There was no obvious murmur in the valves. The abdomen was soft with no pressing pain or rebound tenderness. The liver and spleen were normal. There was edema on both ankles and feet.

Nervous System Examination:
Suad Hameed Salah Al-dahan was alert. She was depressed. She was not able to speak. She regularly suffered from anxiety. Her memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, the diameter was 3 mms. Both eyes had sensitive responses to light stimuli. Both eyeballs could move freely. The nasolabial fold and forehead wrinkle pattern were symmetrical. Her ability to close her eyes was a little weak. There was no tooth deflection. The tongue didn't protrude out of the mouth. The tongue muscle was atrophied. She was not able to move her tongue. Both soft palates could be raised, but the strength was weak. The uvula was centered in the oral cavity. The pharyngeal reflex was slow. The cheeks could be expanded normally. The neck was soft. The ability of the shoulders to turn or shrug was weak. The neck was protruded.
The muscle power of both upper limbs was at level 3-, the gripping strength of both hands was at level 3+, and the muscle power of both lower limbs was between levels 0-1. The muscle tension of both upper limbs was lower. The muscle tension of both lower limbs was normal. The ankle reflex was abnormal. The knee reflex was weaker than normal. The interphalangeal muscle of both hands, the big thenar muscle, the minor thenar eminence, both upper limbs, bilateral supraspinous muscle, infraspinous muscle and both lower limbs had serious muscular atrophy. The abdominal reflexes were abnormal. The bilateral palm jaw reflex was negative. The sucking reflex was positive. The bilateral Hoffmann’s sign and bilateral Rossolimo's sign were negative. The deep sensation and superficial sensation of both sides were normal. Suad was able to complete the finger-to-nose test on both sides, the rapid rotation test and the finger-to-finger test. She was not able to do the heel-knee-tibia test. The meningeal irritation sign was negative.

Treatment:
After admission, Suad received relevant examinations and was given 3 neural stem cell injections and 3 mesenchymal stem cell injections to improve circulation, nourish the neurons, repair the nerves, protect the organs and we used a non-invasive ventilator to assist with her breathing. Parameters: BiPAP/st, IPAP23cmH2O, EPAP6cmH2O, Br 14/min. We also gave Suad daily physical rehabilitation training.

Post-treatment:
After the treatment was completed, Suad was able to eat more food and swallow much better. There was less salivation. The respiration improved. Sat was 95-97%. The muscle power of both upper limbs increased to level 4, the gripping strength of both hands increased to level 4+. The muscle power of the left lower limb increased to level 2+, and the muscle power of the right lower limb increased to level 2. Suad was more emotionally stable.

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