Amyotrophic Lateral Sclerosis Case Study

AMYOTROPHIC LATERAL SCLEROSIS 11

AmyotrophicLateral Sclerosis Case Study

Amyotrophiclateral sclerosis (ALS), also known as Lou Gehrig`s disease, is afast developing, habitually lethal neurological illness that affectsneurons (nerve cells) that control voluntary muscles. Commonsymptoms of the disease include muscle twitching, stiff muscles andconsistent muscle wasting. Difficult breathing, speaking andswallowing are other primary symptoms of the disease. ALS is one therecognized motorneuronsicknesses. The condition develops gradually as the essential nervesof the voluntary muscles die over time. Motor neurons are found inthe spinal cord, brain stem and the brains. Information codes fromupper motor neurons (brain cells) moves to lower motor neurons(spinal cord cells) and then to specific muscles. This implies thatpatients suffering from ANLs cannot control regular voluntary bodyparts since the neurons are dead. As a result, the muscles becomeweak and begin wasting away. Finally, the brain cannot initiate anddirect voluntary muscle movement in patients suffering from thedisease in the advanced stage.

Harmon(2012) asserts that ALS mainly affects patients above fifty yearsold. Patients that suffer from the disease die within five years. However, Peter Hawking, the renowned Cambridge professor, is anexception. Therapists diagnosed his disease at twenty-one years, andthey expected he would die before twenty-fifth birthday. Theprofessor is now over seventy years old, an achievement that patientsaccomplish. The new development on the disease prompts furtherresearch on the development, control, treatment and management of thedisease. The following case study focuses on the control of ALSdisease on adult patients. The analysis follows health managementstrategies of a patient identified as john.

PatientCase Study

Disease:Amyotrophic Lateral Sclerosis

  • Gender: Male

  • Age: 51 years old

  • Patient’s name: John

  • Treatment cycles: four

  • Nationality: American

FamilyBackground

John’smaternal grandfather and uncle suffered ALS. For many years, he had arelatively healthy life. However, he sustained mild bomb injuryduring his service years. Initially, he ignores the muscle stiffnessbecause he assumes it results from previous injuries and advancedage. In 2008, the patient suffers from atrophy and muscular weaknessfrom 2006. In addition, he suffers from dysarthria ever since 2008.

Treatmentplan

John’sprimary treatment plan is stem cell cycle treatment. He undergoesfour treatment cycles. In addition, he also receives complementarytreatment programs such as counseling. According to the physicians,the patient will also take Riluzole drug that helps to suppressproduction of harmful cells. The physicians administered the patientwith six umbilical cord blood-derived stem cell (UCBSC) packets usingintravenous (IV) injection and lumbar puncture (LP) as demonstratedhere:

Treatment1:

Number

Cell Type

Delivery Method

1.

June 4, 2008

UCBSC

IV

2.

June 11, 2008

UCBSC

LP

3.

June 16, 2008

UCBSC

LP

4.

June 27, 2008

UCBSC

IV

5.

June 27, 2008

UCBSC

LP

6.

June 30, 2008

UCBSC

IV

Treatmentprogram:

Johnreceived six umbilical cord blood-derived stem cell (UCBSC) packagevia lumbar puncture (LP) and intravenous (IV) methods.

Treatment2.

Thepatient receives four (UCBSC) packets, as well as a couple ofautologous bone marrow stem cell (BMSC) packets using intravenouslumbar and injection as the schedule below demonstrates.

Number

Cell type

Delivery method

1

February 18, 2009

UCBSC

IV

2

February 20, 2009

UCBSC

LP

3

February 27, 2009

UCBSC

LP

4

March 6, 2009

BMSC

LP

5

March 9, 2009

UCBSC

IV

6

March 13, 2009

BMSC

LP

Consequentreport

Johnimproved significant improvement after the treatment at the hospital.The treatment program lasts for over half a year. The primaryimprovement is increased muscle strength that enabled him to walk forlonger distance without experiencing fatigue. Besides, his speechclarity improves significantly.

Treatment3

Duringadmission for the third schedule treatment, John suffered fromdysphagiaand dysarthria. Tongue muscles were trembling and atrophied. Thelimbs trembled while the pharynx was feeble. The upper limbs andlower limbs’ strength was grade four and three respectively.

Treatmentplan: therapists administered John with seven umbilical cord-derivedmesenchymal stem cell (UC-MSC) packets. The medication wasadministered using lumbarpuncture (LP) and intravenous (IV) injection.

Cell type

Delivery method

Side effects

Number

March 5, 2010

UC-MSC

IV

none reported

1

March 10, 2010

UC-MSC

LP

none reported

2

March 15, 2010

UC-MSC

IV

none reported

3

March 19, 2010

UC-MSC

LP

none reported

4

March 24, 2010

UC-MSC

IV

none reported

6

March 29, 2010

BMSC

LP

none reported

5

April 2, 2010

UC-MSC

LP

none reported

6

April 7, 2010

UC-MSC

IV

none reported

7

Dischargestatus:

Afteradministration with the drug, he was discharged as his pronunciation,fine motor movement and lib strength improved drastically.

Treatment4:

Admissionstatus:

Pharynxreflection is feeble. Tongue muscles had fasciculation and wereatrophied. Limbs’ muscle tension remained close to normal. Pharynxreflection is weak. Limbs’ muscle tension remained normal and theestimated strengths of the upper limbs’ muscle is grade 3. Thetreatment program involved administration of eight umbilicalcord blood-derived stem cell (UCBSC) packs. The packets areadministered two at a go through IV injection.

Number

Cell Type

Delivery Method

Side Effects

1 and 2

February 14, 2011

UCBSC

IV

none reported

3 and 4

February 18, 2011

UCBSC

IV

none reported

5 and 6

February 23, 2011

UCBSC

IV

none reported

7 and 8

February 28, 2011

UCBSC

IV

none reported

Dischargestatus:

Thedoctor claimed that John had plenty of energy and enhanced musclestrength in both his trunk and limbs. His speech had also improvedsignificantly since he could tongue comfortably. Besides, he couldsit on his bed, as well as walk in a stable manner, even with nosupport.

Sideeffects of the treatment

Thetreatment plan had zero side effects on the patient. In fact, thestemcell cycle treatment is 100% safe depending on John’s treatmentoutcome.

Diseasehistory

Johnis a marine veteran and occasionally goes fishing as a hobby. However, he complains that he is unable to cast fishnets because hishands are feeling weak. Besides, he cannot move at a fast speed as hecould in the past. He has lived a healthy life with no episodes ofserious diseases affecting him. He is a father of four and he decidesto visit a doctor after he experiences general weaknesses on thejaws, arms, legs and hands (BeikeBiotechnology Co., 2014).

ALSSymptoms

Firstsymptoms of the disease are so minor that John assumes the weaknesscomes from natural degeneration. Some of the symptoms the patientssuffered include cramps, fasciculations, and weakness of arms andlegs’ muscles, stiff muscles (spasticity),difficulty swallowing and chewing, nasal and slurred speech. Johnalso complained of “slapping” gait that is attributed to footdrop. The most affected muscles are the arms and legs (Balendraet al., 2014). John stumbles occasionally and is unable to hold heavy itemssteadily because he suffers from “limb onset”. He then suffersfrom “bulbar onset” ALS that causes speech difficulties. Atrophyand muscle weakness then spreads to other body parts over time. Thephysicians diagnosed the disease after both the upper and lowerneurons stop functioning. Common symptoms that warned the patientsthat the lower motor neurons are damaged include fasciculations,muscle cramps, muscle atrophy and weakness (Amyotrophic LateralSclerosis (ALS) Fact Sheet, 2015).

Diagnosis

Johnis convinced that the muscle weakness he feels, as well as we asspeech slur he develops are changes that result from old age.However, his therapists advise him that he requires undergoing sometests that will rule out ALS. The physician integrateselectrophysiologic and other particular clinical symptoms as theWorld Federation of Neurology (WFN) (Chio et al., 2013).

Inaddition, the physician also recommends John to undergo a geneticanalysis of fluids found in the muscles affected by the disease. Theanalysis confirmed that he was suffering from ALS condition (Balendraet al., 2014).

Physicalcondition

Bythis stage, he is unable to walk due to severe stiff muscles. Thismeans that he also needs a personal assistant because he cannot domost of his personal needs such as cooking, cleaning and even goingto the toilet (Radunovic, 2013).

Second,the patient suffers from fuzzy thinking, experiences fatigue andconstant headaches. Besides, he is vulnerable to pneumonia. Theworst condition that threatens his life at this phase is respiratoryfailure. Another major problem is the inability to eat comfortablysince the patient cannot control the food pipe’s muscles(Radunovic, 2013).

HealthComplications

Oneof the common complications John suffers is respiratory strain.Breathing problems deteriorate over time. The physician prescribesmedication that relaxes the muscles to relieve fear, discomfort andanxiety that results from respiratory inadequacy (Chio et al., 2013).Balendraet al. (2014)asserts that many ALS patients die when asleep.

ALSdoes also cause malnutrition. One of the arteries located in thelungs may block (pulmonary embolism),thereby, make it hard for a patient to swallow food. Heartabnormality arises due to irregular heart rhythm. The conditionhappens when either fluid or food particles enter lung muscles.

References

BeikeBiotechnology Co. (2014). Patient Case Study: Amyotrophic LateralSclerosis. Web. Retrieved on March 8, 2015 fromhttp://beikebiotech.com/wp-content/uploads/2014/04/ALS-Case-Study-American-Male-51.pdf

AmyotrophicLateral Sclerosis (ALS) Fact Sheet, (2015). National Institute ofNeurological Disorders and Stroke. Web. Retrieved on March 8, 2015http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis/detail_ALS.htm

ChiòA, Hammond E.R, Mora G, Bonito V, Filippini G. (2015). Developmentand evaluation of a clinical staging system for amyotrophic lateralsclerosis. J Neurol Neurosurg Psychiatry. 86(1):38-44. doi:10.1136/jnnp-2013-306589

BalendraR, Jones A, Jivraj N, Knights C, Ellis CM, Burman R, Turner MR, LeighPN, Shaw CE, Al-Chalabi A. (2014). Estimatingclinical stage of amyotrophic lateral sclerosis from the ALSFunctional Rating Scale. AmyotrophLateral Scler Frontotemporal Degener, 15(3-4):279-84.

RadunovicA., Annane D., Rafiq M.K, Mustfa N. (2013). Mechanicalventilation for amyotrophic lateral sclerosis/motor neuron disease.CochraneDatabase Syst Rev. 28(3).27-44.

Harmon,K. (2014). How Has Stephen Hawking Lived Past 70 with ALS? ScientificAmerican.