Disease stabilisation, improved motor function and less dependence on respiratory support in motor neurone disease

History

Before the illness developed, the patient had long maintained a high level of activity at home and physically.

The first marked symptoms began to appear in 2023–2024. Weakness first appeared in the arms, particularly proximally: it became increasingly difficult for him to raise his arms and carry out his usual tasks. The weakness later spread to the legs and took on a gradually progressive course.

As the motor deficit increased, the patient first began to use a walking stick and was then obliged to move to a wheelchair. Difficulties appeared even with basic daily tasks, including feeding himself and moving about.

Electrophysiological investigation showed widespread chronic and active motor neuronopathy involving several levels – bulbar, cervical, thoracic and lumbosacral.

On discharge from a specialist centre the diagnosis was formulated as motor neurone disease, and the patient was also being established on non-invasive ventilation.

Before treatment

At the time he came to us the clinical picture was one of marked motor deficit.

The main problems were:

• a tetraparesis with predominantly more marked involvement of the left side
• considerable weakness of the arms and legs
• marked muscle wasting
• substantially restricted independent walking
• the need for help from another person when standing up and moving
• a high risk of falling
• markedly reduced independence at home
• rapid physical fatigue
• reduced overall endurance
• the need for non-invasive respiratory support

Before the programme the patient could move only short distances with the help of another person and additional support. The specialists regarded his walking as unsafe, and most changes of position required assistance.

The main aims of treatment were to stabilise a progressive disease, preserve the motor reserve that remained, increase muscle strength and widen the patient's independent mobility as far as possible.

The programme

A personalised combined programme of cell, immunoregulatory and neuroregenerative therapy was drawn up for the patient.

The protocol included:

• therapy with mesenchymal stromal cells
• use of regulatory T cells
• a systemic cell component
• neurally targeted support
• comprehensive follow-up and rehabilitation work

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 his family noted substantial positive functional change.

Disease stabilisation

One of the most important results was that the previous clinical progression of the disease stopped.

The patient no longer noticed the further steady decline in motor capacity that had characterised the period before treatment.

Muscle strength

Increased strength in the limbs was noted.

The patient performed active movements of his arms and legs better, and his ability to use the muscle capacity he retained when standing up and moving improved.

Walking and mobility

With the increase in strength, his ability to move about on his own gradually improved.

He began to walk more, his movements became more assured and the amount of help he needed from others decreased.

Whereas before treatment walking was severely restricted and required constant help and additional support, after the therapy the patient made considerably more active use of his own motor capacity.

Physical endurance

Overall physical endurance also increased considerably.

The patient stayed active for longer, tolerated a greater amount of physical exertion and tired less during everyday tasks.

Respiratory function

Particularly significant positive change was noted in respiratory function.

Before treatment the disease had already required the patient to be established on non-invasive ventilatory support.

After the therapy a substantial partial compensation of the respiratory impairment occurred: the need for respiratory support decreased considerably, and the time for which non-invasive ventilation was used fell to roughly an hour at most.

This was accompanied by longer periods of unaided breathing and became one of the most functionally significant results for the patient.