Name: Enver Gulsoy
Sex: Male
Nationality: UK
Age:64Y
Diagnosis: 1. Motor Neuron Disease 2. High Blood Pressure
Discharge Date: 2019/08/11

Before treatment:
The patient had no inducement to develop right arm weakness 18 months ago and then gradually it aggravated to left arm muscle weakness, muscle atrophy, head and neck weakness. In November 2018 his voice was low and weak and his swallowing function became difficult so he went to the hospital in December 2018 and early 2019. He was diagnosed with "motor neuron disease" by electromyography and MRI. The doctor gave "riluzole" orally and it had no effect. Since January 2019 the progression of the patient's condition has been accelerated. At present it is difficult for him to lift both arms, he is walking with the help of crutches and has poor exercise endurance. He has  obvious weakness of the left leg, muscle atrophy of the proximal extremities and shoulder and back muscles. There is tongue muscle, pharynx and throat muscle weakness and  he was unable to take care of himself.
His mental condition was not good, he had poor sleep, a semi-liquid diet, his urination and defecation functions are basically normal. He used to have high blood pressure.

Admission PE:
Bp: 133/96mmHg, Hr: 96/min, breathing rate 20/min. Height 156cm, weight 61kg, body temperature: 36.3 degrees. The patient had good nutrition status and normal physical development. There was no injury or bleeding spots of his skin and mucosa, congestive throat and normal tonsils. He has a symmetrical chest, reduced breathing activity, coarse respiratory sounds bilaterally and coarse rales were heard. He had a regular heart rate and rhythm (96/m), no obvious murmur heard, a protuberant abdomen, no tenderness and masses, normal liver and spleen and no edema of the legs.

Nervous System Examination:
The patient was alert, had low spirit, slurred  low speech, normal memory, calculation and orientation abilities. Both pupils were equal in size, with a diameter of 3 mm,  a sensitive reaction to light, no nystagmus and the eyeballs can move freely. He had a symmetrical forehead wrinkle and nasolabial fold, his eyes can close forcefully, the cheeks cannot bulge, his  tongue can extend out in the middle but there was muscle atrophy. His tongue movement was not flexible, especially when moving up and down and he had a weak soft palate bilaterally. The uvula was in the middle, normal pharyngeal reflex, his neck-turning and shrug were weak. There was muscle atrophy in the proximal ends of the 4 limbs, bilateral sternocleidomastoid, shoulder girdles and latissimus dorsi. Muscle power of the right arm proximal and distal end is grade 2- and 2+ respectively. Right gripping power is grade 3. Muscle power of the left arm proximal and distal end is grade 2 and 3 respectively. Left gripping power is grade 3+. Muscle power of right and left leg is grade 4 and 4-, respectively. Muscle tone of all 4 limbs is normal. Tendon reflex of both arms was reduced. Tendon reflex of both legs is normal. The bilateral palm-jaw reflex is positive, bilateral Hoffmann sign is negative, bilateral Rossilimo and Babinski signs are positive. Bilateral deep and shallow sensation is normal by gross examination. Only the thumb to forefinger movement can be finished on the right side, while only thumb to little finger cannot be done on the left side. Finger to nose movement cannot be done, bilateral fast alternate movement is clumsy and the bilateral heel-knee-tibia cannot be done. The meningeal irritation sign is 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 (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 the patient got improvement in his breathing function. He could also bulge the cheeks and maintain the bulge for 5 seconds. His swallowing function got better, the saliva reduced and his speech got clearer. His arm movement got better with the left hand now being able to reach his eyebrows and the right hand reaching to the chest. Muscle power of the left leg increased to level 4. His limbs were more flexible and he could now walk faster.