Case 2 History
The patient was a 34 year-old male with an 8-9 year history of ALS. His early symptoms in the course of his disease (2006) involved fasciculations of the motor groups of the upper extremities and spasticity in his lower extremities. His peripheral muscles were primarily involved at first. In December 2007 he was fitted for BiPAP and had placement of a G-tube. At the date of his last visit in June 2011, he was completely wheelchair bound, dependent for transfers, used eye movements for communication, wore BiPAP 24 hours per day, and used a G-Tube for the last 4 years. His physical exam showed atrophy and fasciculations throughout his musculature with minimal fiber flexor strength. He had increased tone and spasticity in his lower extremities. Reflexes were 4+. A detailed terminal course was not available but his entire course lasted 6 years.
