Edina Hodzic-Amyotrophic Lateral Sclerosis (ALS)-(Austrian)

Patient Name: Edina Hodzic
Gender: Female
Age: 45 years old
Nationality: Austrian
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)

Condition on Admission：
The patient was admitted with the diagnosis of amyotrophic lateral sclerosis, presenting with a chief complaint of progressive limb weakness and muscle atrophy for more than 2 years. Two years ago, the patient developed left foot weakness without obvious inducement, followed by spasm and pain of the left upper limb with severely limited mobility. Her condition gradually deteriorated and involved all four limbs, manifesting as limb stiffness, weakness, muscle atrophy and pain. One and a half years ago, after relevant examinations at a local hospital, she was diagnosed with amyotrophic lateral sclerosis (ALS). She received stem cell therapy in Istanbul, Turkey in October 2025, and heat shock therapy in Miami, USA in February 2026. Neither treatment was effective, and her disease continued to progress. At present, she had decreased voice volume, occasional choking on water, and reduced sputum clearance capacity. She had completely lost motor function in all four limbs. She was on oral medications including baclofen tablets, mirtazapine, sertraline, dronabinol, etc. Her condition had not improved and has been progressively worsening.

Physical Examination on Admission:
Pulse: 88 beats per minute, Respiratory rate: 20 breaths per minute, Blood pressure: 110/83 mmHg, Oxygen saturation: 96%. She has normal development and fair nutrition. No cyanosis of the lips, no pharyngeal congestion. Thoracic respiratory movement is basically normal. Breath sounds are clear in both lower lungs, with no obvious dry or moist rales. Heart sounds are strong and regular, and no obvious murmurs are heard over each cardiac valve area. The abdomen is flat and soft, without tenderness or rebound tenderness. The liver and spleen are not palpable below the costal margin. No edema is seen in both lower limbs.

Neurological Examination:
The patient was conscious and in fair spirits. Her voice was low and her articulation is indistinct. Her calculation, memory and orientation were all normal. Bilateral pupils were 3 mm in diameter with brisk light reflexes. Ocular movements were full in all directions and no nystagmus was noted. Soft palate elevation was slightly weak, tongue movement was weak with marked atrophy. She had a weak cough and occasional choking on water. Neck rotation and shoulder shrugging were weak. Bilateral sternocleidomastoid muscle strength was 3+ grade, bilateral trapezius muscle strength was 3 grade. Both upper limbs were rigid and flexed with limited movement, and marked pain occurs during passive stretching. Proximal muscle strength of the left upper limb was 0 grade, distal strength 1 grade, grip strength 1 grade; proximal muscle strength of the right upper limb is 2 grade, distal strength 2+ grade, grip strength 2+ grade. Both lower limbs were rigid; left lower limb muscle strength 0 grade, right lower limb muscle strength 1 grade. Limb muscle tone was markedly increased. Obvious muscle atrophy was present in all four limbs. Tendon reflexes were hyperactive in both upper limbs, and tendon reflexes could not be elicited in both lower limbs. Bilateral Hoffman sign was positive, bilateral Babinski sign was negative. Meningeal irritation signs were negative.

Treatment Course:
The admission diagnosis of amyotrophic lateral sclerosis was confirmed. She was administered neural stem cells to repair motor nerve injury, and mesenchymal stem cells for neurotrophic, endocrine and immune support. Adjuvant CAST therapy with medications including edaravone, neurotrophic factors and reduced glutathione was given, combined with comprehensive rehabilitation therapy.

Post-Treatment Status:
The patient’s condition is improved. She is in good spirits with improved sleep and enhanced motor function. Her voice volume is increased and her enunciation is clear. Strength of the head and neck is improved: bilateral sternocleidomastoid muscle strength is 4+ grade, bilateral trapezius muscle strength is 3+ grade. Limb muscle tone is significantly improved, and the range of motion of the shoulder and elbow joints is markedly increased. Proximal muscle strength of the left upper limb is 2 grade, distal strength 1+ grade, grip strength 2 grade; slight active grasping movement of the left hand can be observed. Proximal muscle strength of the right upper limb is 3 grade, distal strength 3+ grade, grip strength 3+ grade. Left lower limb muscle strength is 1 grade, right lower limb muscle strength 1+ grade. In the supine position, she can maintain hip flexion and knee flexion with heel support for a certain period of time and perform slight side-to-side swinging. Slight muscle contraction is visible in the left toes, and minor active movement can be seen in the right toes. Pain is significantly relieved. Tendon reflexes of both upper limbs are normal, and tendon reflexes of both lower limbs are roughly normal. Bilateral Hoffman sign remains positive, and Babinski sign is negative. The previously elevated muscle tone of both upper limbs is markedly reduced compared with admission; muscle tone of both lower limbs is normal. Her energy, physical fitness and exercise endurance are improved.