Case Analysis for Motor Neuron Disease
By Bo Cheng, Like Wu, Xiaojuan Wang and Susan Chu
Wu Medical Center

The motor neuron diseases (MNDs) are a group of progressive neurological disorders that destroy motor neurons, the cells that control essential voluntary muscle activity such as speaking, walking, breathing, and swallowing.  Normally, messages from nerve cells in the brain (called upper motor neurons) are transmitted to nerve cells in the brain stem and spinal cord (called lower motor neurons) and from them to particular muscles.  Upper motor neurons direct the lower motor neurons to produce movements such as walking or chewing.  Lower motor neurons control movement in the arms, legs, chest, face, throat, and tongue.  Spinal motor neurons are also called anterior horn cells.  Upper motor neurons are also called corticospinal neurons.

When there are disruptions in the signals between the lowest motor neurons and the muscle, the muscles do not work properly; the muscles gradually weaken and may begin wasting away and develop uncontrollable twitching.  When there are disruptions in the signals between the upper motor neurons and the lower motor neurons, the limb muscles develop stiffness, movements become slow and effortful, and tendon reflexes such as knee and ankle jerks become overactive.  Over time, the ability to control voluntary movement can be lost.

Although there are now gene test for some MNDs there are no specific tests to diagnose most MNDs.  Symptoms may vary among individuals and, in the early stages of the disease. MNDs may be similar to those of other diseases, making diagnosis difficult.  A physical exam is followed by a thorough neurological exam.  The neurological exam is to assess motor and sensory skills, nerve function, hearing and speech, vision, coordination and balance, mental status, and changes in mood or behavior.
There is no cure or standard treatment for the MNDs.  Symptomatic and supportive treatment can help people be more comfortable while maintaining their quality of life.

Case Presentation
Carol Bell came to Wu Medical Center with a history of motor neuron disease which was diagnosed in another hospital. She presented with abnormal sensation in her lower limbs, inability to walk and could barely communicate with her neighbors.
Based on the symptoms presented, physical examination which was corroborated with gene test, Carol Bell diagnosis was confirmed as one of the motor neuron diseases.

Treatment
Carol Bell received the most advanced stem cells therapy in Wu Medical Center. Treatment included: neural stem cells (NSCs) located accurately; the cells differentiate into targeting cells. In this disease, we need NSCs to differentiate into motor neuron. Carol Bell was managed using stem cells therapy for 2 weeks. This was done under a strict medical procedure to prevent any complication that may arise and it was accompanied with intensive rehabilitation. The course of therapy was planed and guided by experienced senior physician. This rehabilitation was done by a physiotherapist.

Post-treatment
After two weeks of treatment, patient is able to communicate and write. Her motor function and exercise tolerance have improved. She can walk with little aid. This means that there has been an improvement in muscle power of both upper and lower limbs. Sensation has also returned. She able to undertake basic activities and quality of life has generally improved.

Conclusion
Though there is no cure for MNDs, Stem cells therapy can stop the disease getting worse, fix some nerve functions, help people be more comfortable while maintaining their quality of life