Clinical case 13
Stabilisation and functional improvement in ALS
woman, 73 · Italy
Patient record
- Patient
- woman, 73
- Country
- Italy
- Diagnosis
- amyotrophic lateral sclerosis (ALS) with motor, bulbar and respiratory features
- Main features before treatment
- progressive muscle weakness and wasting, mainly on the left, dysarthria, dysphagia, reduced strength in the left arm and left leg, respiratory impairment with hypercapnia requiring regular nocturnal non-invasive ventilation
- Treatment given
- an individual combined cell, immunoregulatory and neuroregenerative programme
- Course after treatment
- the previous clinical progression stopped, improved swallowing, partial increase in strength in the left limbs, partial compensation of the respiratory impairment and fewer hours of nocturnal non-invasive ventilation needed
History
The first features of the disease appeared in the summer of 2024, when the patient noticed a gradual loss of bulk in the interosseous muscles and weakness of the left hand.
From September 2024 dysphagia and progressive dysarthria began to join the motor symptoms. Weight loss, increasing general weakness and further wasting of the muscles, mainly of the left arm, followed.
In March 2025, after full investigation, a diagnosis of motor neurone disease consistent with ALS was confirmed. Electromyography showed signs of active and chronic denervation in the muscles of all four limbs.
As the disease advanced, marked respiratory impairment also developed. Hypercapnia, severe sleep-disordered breathing and desaturation were recorded, and the patient was established on nocturnal non-invasive ventilation. This was used regularly for a substantial part of the night – from roughly 22:30 to 06:00.
Before treatment
At the time she came to us the patient's most significant problems were:
- progressive muscle weakness
- marked wasting and reduced strength in the left arm
- reduced strength in the left leg
- dysarthria
- dysphagia, particularly for liquids
- episodes of aspiration of liquid
- a weakened cough
- respiratory impairment with hypercapnia
- the need for regular nocturnal non-invasive ventilation
- reduced general physical endurance
The neurological deficit was asymmetrical and most marked on the left: strength in individual muscle groups of the left hand was reduced to about 3/5, and weakness of the left foot was also found.
Swallowing assessment confirmed dysphagia, primarily for liquids, with a risk of aspiration.
The main aim of treatment was to stop further clinical deterioration, preserve the motor and respiratory reserve that remained and support as far as possible the patient's most important functions – movement, swallowing and breathing.
The programme
A personalised combined programme of cell, immunoregulatory and neuroregenerative therapy was drawn up for the patient.
The protocol that followed included:
- therapy with mesenchymal stromal cells
- use of regulatory T cells
- systemic and neurally targeted cell components
- concentrated exosome therapy
- intranasal peptide support
- two sessions of neurotherapy
The exact doses, the sequence of procedures and the technical parameters formed part of an individual internal protocol.
Course after treatment
After the programme the patient and those close to her noted stabilisation and an end to the steady deterioration seen previously.
Disease stabilisation
One of the most important results was that the previous clinical progression stopped.
The patient no longer noticed the further steady increase in motor, bulbar and respiratory impairment that had characterised the period before treatment.
Swallowing
Positive change in the dysphagia was noted.
Swallowing became more assured and difficulties with food and liquids lessened. This mattered a great deal to the patient given the swallowing impairment confirmed at the outset and the risk of aspiration.
Motor function
There was also a partial increase in muscle strength, mainly in the left limbs, where the motor deficit had been most marked before the programme.
The patient made better use of the movement retained in her left arm and left leg, which had a positive effect on her overall motor activity.
Respiratory function
Positive change in breathing was noted separately.
Before treatment the patient required regular use of non-invasive ventilation for a substantial part of the night.
After the programme partial compensation of the respiratory impairment occurred: her respiratory state became more stable, tolerance of periods of unaided breathing improved and the number of hours for which she required nocturnal non-invasive ventilatory support fell.
This was therefore not only a subjective improvement in breathing comfort, but a reduction in dependence on respiratory support at night.
Outcome
After the individual programme the most significant results were:
- the previous clinical progression of the disease stopped;
- no further steady deterioration
- improved swallowing
- a partial increase in strength in the left limbs;
- stabilisation of the motor state
- partial compensation of the respiratory impairment
- fewer hours of nocturnal non-invasive ventilation required
- longer periods of more independent breathing
For a patient with ALS the combination of stabilisation of a previously progressive disease with improvement in several critically important functions at once – swallowing, muscle strength and respiratory autonomy was particularly significant.
Here the positive change showed itself not only in an end to the previous deterioration, but in a real widening of the patient's functional capacity, including reduced dependence on nocturnal respiratory support.
This case is described from the patient's medical records and observation over the period after the programme. No personal data is published. The course of the disease and the response to treatment differ from patient to patient.