Idiopathic encephalopathy, involution of left frontal and temporal lobe, right cerebellum, initial signs of dementia, aphasia, mild ataxia.
We had the honour to accept at our Cell Therapy Clinic of National Medical University and Center 'EmCell' Mr. J.S.M., DOB September 5, 1936. Mr. J.S.M. stayed at Cell Therapy Clinic from 16 to 20 of May, 1996. Mr. J.S.M. was attended by his daughter Ms. Maureen M., and Dr. W.C.R..
Beforehand we were forwarded the file covering the history of the case for recent years. The file included valuable records by:
- Carroll Ramsayer M.D. (Neurology) 11-13 and 12-13 1994
- Maynard Levenick M.D. (Radiology) 11-4-94 (MRI)
- Diana Van Lanker Ph.D. (Neurolinguistics) 5-2-95
- Jason S. Kahan Ph.D. (Psychology) 12-1-94
- Jeffrey Shaeffer, Ph.D. (Neuropsychology) 9-18-95
- Victor Henderson, M.D. (Neurology) 1-23 and 5-2 1995
- Scott Grafton, M.D. (Nuclear Neurology) 4-4-95 (PET)
- Steven Brigham, Ph.D (Psychology) 3-21-95
- R.D.Jones, Ph.D. (Neurology) 10-2-95
- Thomas J. Grabowsky (Neurology) 10-3-95
- Ismael Mena, M.D. 1-24-96 (Brain Spect)
- George Chow M.D. 4-25-96, 4-27-96
- Ulf Lando, M.D. 4-24-96
- Ramzi Kiriakos M.D. 4-23-96
- Ed Jefferson, M.D. 4-26-96 (MRI)
- Faud F. Rafidi M.D. 5-9-96.
Chemistry and Serology Lab Studies from 5-11-93, 5-17-94, 5-16-95, 4-23-96, 4-25-96, 4-24-96, 4-27-96, 11-2-94
Our own investigation lead us to conclusion quite similar to those of our colleagues.
We established the following diagnosis:
Idiopathic encephalopathy, involution of left frontal and temporal lobe, right cerebellum, initial signs of dementia, aphasia, mild ataxia.
We should note that the patient made an impression of a more severe state than we could conclude from the received reports. He was aphasic, morose, with inattentive not concentrated sight. He replied in single words with poor articulation, with spending a long time thinking the question over. He often turned inside his mind and seemed absent. In the process of treatment procedures he easily fell asleep. His face appeared like a mask void of emotion.
We were troubled a lot by his walk. He had substantial wobbling with sharp tips of the head and body forward while stepping over even a small obstacle (the deterioration of the movement coordination connected with atrophy of the cerebellum). We were not informed about these symptoms in the received reports.
From the internist's point of view Mr. J.S.M. is a man older than his age, of athletic habit, safe in the somatic sense. Pulse regular 64-76 beats per minute, normal blood pressure 75-80 to 115-120 mm Hg. Heart tones were normal including sound and melody. Above the lungs there a clear percussion sound. Palpation of abdomen revealed no particularities. Skin was clear.
Tests:
16.05.96 Erythrocytes 4,8*1012/l, Hb 138 g/l, color index 0.8, throbocytes 280*109/l, leukocytes 5.2*109/l, stab neutrophils 4%, segmented neutrophils 57%, eosinophiles 4%, lymphocytes 32%, monocytes 2%, ESR 8 mm/hr.
20.05.96 Erythrocytes 4,2*1012/l, Hb 130 g/l, color index 0.9, thrombocytes 180*109/l, leukocytes 4.0*109/l, stab neutrophils 2%, segmented neutrophils 71%, eosinophiles 3%, lymphocytes 20%, monocytes 4%, sedimentation reaction 3 mm/hr.
16.05.96 Lymphocytes 1664/mkl, T-lymphocytes (CD3) 965/mkl (58%), T-helper (CD4) 532/mkl (32%), T-suppresser(CD8+) 200/mkl (12%), CD4+/CD8+ 2,6, NK (CD16+CD56) 200/mkl (12%), B-lymphocytes (CD19+) 283/mkl (17%), b2 microglobulin 3.2, IgA 2.8, IgD 8.6, IgM 1.02.
16.05.96 Total protein 76.3 g/l, Albumin 50%, globulin 50%, alfa1 4.4%, alfa2 9.8%, beta 14.8%, gamma 21%, C-reactive protein ++,
16.05.96 Bilirubin total 12.5 mmol/l, direct - neg., indirect 12.5 mmol/l, ALT 0.30 mmol/l, ACT 0.155 mmol/l, cholesterol 3.4 mmol/l, urea 13.3 mmol/l, creatinine 0.135 mmol/l.
20.05.96 Bilirubin total 14.0 mmol/l, direct - neg., indirect 14.0 mmol/l, thymoltest2.0 units, ALT 0.31 mmol/l, ACT 0.22 mmol/l, cholesterol 3.3 mmol/l, urea 12.5 mmol/l, creatinine 0.135 mmol/l.
16.05.96 ECG regular sinus rhythm, signs of mild changes of myocardium.
18.05.96 Examination by ophthalmologist.
Conclusion. Frontal part of the eyes is not changed. Optical media are lucid. In the eye fundus the disks of ophthalmic nerves have normal shape, are pallid-pink. The arteries are narrow and have signs of sclerosis. There are seen circles of peripappilary atrophy of Chorioidea. In the zones of macula nothing pathological was noticed.
Diagnosis: Mild myopia. Angiosclerosis of the retina of both eyes.
18.05.96 Examination by neurologist.
The appearance is older than chronological age. Eye slots are symmetric, pupils s=d, the movements of eye apples in full range. Ny - no, left nasolabial crease is smoothed, tongue in the mid line, swallowing is free. Active movement in full amount, muscular strength is satisfactory, muscle tonus is intact, reflexes s=d are of medium vivid. Strumpfel symptom in both sides. Awkwardness while performing tests for coordination in left side. While performing sensible Romberg test - is falling to the left. Pain sensitivity is intact. Asynergies of Babinsky are absent.
Patient exhibits symptoms of deterioration of the brain in the left side.
Recommendations:
a. differential diagnosis between +process and idiopathic atrophy of the brain,
b. contrast angiography,
c. control of retina condition in time.
Mr. J.S.M. received course of Cell Therapy. Action of the Cell suspensions was directed to the restitution of nerve connections, normalization of hemato-encephalic barrier functions, removing of immune aggression against brain cells and to the restitution of micro circulation.
16.05.96 Implantation of the Cell suspension sample 3038 AM 284 subcutaneously in the frontal abdomen in two depots in amount 2 ml each.
17.05.96 Transplantation of the Cell suspension sample 3038 A 284 i/v, amount 3.0 ml.
18.05.96 Transplantation of the Cell suspension sample 3038 A 284 i/v, amount 1.2 ml.
Implantation of the Cell suspension sample 3038 AM 284 subcutaneously in the frontal abdomen in two depots in amount 2 ml each.
20.05.96 Transplantation of the Cell suspension sample 3038 A 345 i/v, amount 2.8 ml.
Implantation of the Cell suspension sample 3038 AM 345 subcutaneously in the frontal abdomen in two depots in amount 1.4 ml each.
The Cell suspension samples 3038 AM 284, 3038 A 284, 3038 AM 345 and 3038 A 345 possess the mentioned above functional activity and are certified as follow:
| Bacterial sterility test |
Negative |
| Prenatal diagnostic |
| Test with cardiolipid antigen |
Negative |
| Anti - HIV1/HIV2 |
Negative |
| HBsAg |
Negative |
| Fetal diagnostic |
| Enzygnost Anti - HIV1/HIV2 |
Negative |
| HBsAg monoclonal |
Negative |
| Anti - HBc monoclonal |
Negative |
| Anti - CMV/IgG+IgM |
Negative |
| Anti - Rubella Virus/IgG |
Negative |
| Varicella/Zoster |
Negative |
| Toxoplasmosis/IgG |
Negative |
Within the period of treatment there was noticeable reducing of the wobbling while walk and a vanishing of the side tipping. On the May 17 Mr. J.S.M. seemed to be more cheerful, but remained aphasic, replying usually with only one word. He appeared emotionally rigid. He became tired very easily. Appetite improved.
On May 18 and 19 Mr. J.S.M. became more in contact, began to answer questions in a more complete way, there appeared to be a positive emotional attitude to all those around involved in his treatment. He became much more concentrated, attentive and followed the topic of the conversation. There was an obvious improvement of his walk. He became more confident, the ataxia was substantially reduced. The quantity of sleep during the treatment procedures decreased. From May 17 to 19 Mr. J.S.M. denied improvement of his state.
On May 20 and 21 Mr. J.S.M. became more vivid with natural emotional reactions, entered into and initiated conversations, followed them with no sings of absence. His facial expression became more animated and his appearance started to become more age appropriate. It was on May 20 that Mr. J.S.M. first began to verbalize that he felt an improvement in his general state.
Recommendations:
1. The observed improvement of the patient's state in the early phase of treatment is a good prognostic sign for the development of the curative effect within the following 2-3 months after the first course of treatment.
It is recommended that examination and the next course of treatment by means of Cell Therapy should be in July 1996 at our Cell Therapy Clinic.
2. We recommend a continued course of
Pyracetam (Nootropil) - preparation that improves metabolism in the large brain neurons - in total dosage 0.4 (1 capsule 3 times per day) and
Cavinton - preparation, that improves brain circulation, opens collateral vessels and restores micro circulation. The course may consist of 5-8 iv injections and then of 4-6 tablets per day within 2-3- months.
Head of the Cell Therapy Clinic
of National Medical University and Center "Emcell"
professor Alexander Smikodoub.
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