History and findings before starting G-Therapy:

Before G Therapy	After G Therapy
After G Therapy

He is the elder of two children of a non-consanguineous marriage. There is H/o prolonged labor and emergency cesarean section and delayed cry after birth. Birth weight was normal. Till 6 years of age he was absolutely normal and in fact was an above average school boy. In Feb’94, his mother noted drooping of eyelids more in the evening. He gradually deteriorated through 1994 with altered consciousness, motor weakness and debilitating dystonias of face, upper limbs and lower limbs. Consciousness improved in 1995, but he remained bedridden till June 1998, when he was first brought to our centre. In Oct’94 he was investigated in Bombay by a Neurologist and thought to have acquired generalized Myasthenia Gravis but showed no improvement on Wysolone or Mestinon - which he stopped taking.

When brought to our centre, he had to be carried by parents, had continuous dystonias of the entire body, with severe emaciation and difficult speech. He was alert and partially oriented to time, place and person and could indicate toilet needs. Could turn prone but was unable to sit on his own or creep or feed himself.

On examination he had a large head; Head circumference 56 cm. Marked squint with right eye exophthalmos with medial pterygium, left eye ptosis.

Neurologically: There was mild to moderate dysarthria, facial twitching, truncal and all 4 limbs dystonias with marked rigidity of the limbs and truncal weakness. Feet-deformed-into cavovarus.

Improvements note aftet taking G-Therapy for 7 months:

Seven months after G-therapy, he has shown undoubted global improvement which is as surprising as his first MRI scan done in Feb’99 which shows a midbrain tumor with gross hydrocephalus! Unaware of this diagnosis, he was on G-Therapy from June’98 and he has improved all the same.

• His speech is very clear, fast and intelligent.
• He is able to eat dry snacks with own hands.
• He is able to read to some extent.
• His rigidity is markedly reduced.
• Involuntary movements/dystonias are negligible.
• He can come to sit on own, sitting balance is remarkable and he is also moving in the entire house by bottom shifting. Can maintain quadruped position, momentarily.
• Though there is still dysmetria and tremors. Weight bearing is not possible on the feet.
• Left eye ptosis much better than before.
• Also the wasting has disappeared and there is significant weight gain.

Investigations

• Hemogram, Liver Function Tests, Renal Function Tests-done in Oct’94 and Feb 1999 are all normal.
• CT scan chest Oct’94-No focal abnormality in the thymus.
• Motor and sensory nerve conduction studies in Oct’94 and Feb’99-Normal
• MRI Scan Brain Feb’99-Brainstem- midbrain area tumor with severe hydrocephalus.

Discussion

This is an unusual case of dystonia-chorea due to midbrain tumor with hydrocephalus pressing on the basal ganglia structures.

The patient showed gradual deterioration of CNS symptoms and signs from Feb’94 to June’98. He began with eye symptoms and deteriorated to altered consciousness, severe dystonias with gross emaciation inspite of a voracious appetite. The patient has shown dramatic improvement in functional mobility, speech and obvious gain in muscle mass (with normalizing of appetite) after June’98.

Dr. Sabiha A. Sayed
(M.B.B.S.,D.C.H)
Date:29-12-98

Occupational Therapist’s Report -

Condition before G-Therapy as observed on Video:

• Child in vegetative state
• Few active movements
• No sitting ability
• Generalized wasting
• Clawing of fingers

Observations in December 98:

• Can come to sitting position with little support.
• Weight bearing on right U/E is better as compared to left U/E.
• Fair sitting balance.
• No wasting.
• Fair hand-function.
• Cannot maintain the quadruped position.

Observation in February 99:

• Comes to sitting position on his own.
• Good weight bearing/ shifting on both U/E and L/E Bottom shifting.
• Good hand function.
• Improvement in speech.
• Can maintain the quadruped position shortly.

Dharma Prakash Jha
Occupational Therapist
Date: 9-2-99

Recent observation 2002:

Amit has improved phenomenaly in motor and mental functions. He can now walk, run and sing. His memory has improved and has joined the school now. For his parents it is the rebirth of their son.

We are doing his MRI scans every 6 months and his mid brain tumor and hydrocephalus are not showing any change in size. It is very important to note that no other treatment was given to him for his mid brain tumor or hydrocephalus like shunting, radiation or excision. This clearly indicates the role of G therapy in his improvements.

- Dr. Oswal