2014年5月16日台中榮總診斷書

2014年5月16日台中榮總診斷書

Official Diagnosis Report by Taichung Veteran Hospital on May 16, 2014

陳總統民間醫療小組成員 郭正典

【症狀】

Symptoms

情緒及睡眠障礙，睡眠呼吸暫止，認知功能下降，手抖，步態不穩易跌倒，漏尿

Emotional and sleeping disturbances, Sleep apnea syndrome, Cognitive disorder, Hand tremor, Unsteady gait, Easy falling down, Urinary incontinence

【診斷】

Diagnoses

1.  神經退化性疾病，以額顳葉症狀為主要表徵

Neurodegenerative disease, mainly the presentations of fronto-temporal lobe symptoms

2. 阻塞型睡眠呼吸暫止症，重度，經扁桃腺摘除及懸壅垂之整修手術治療

Obstructive sleep apnea syndrome, severe, status post tonsillectomy and uvulopalatopharyngoplasty surgeries

3. 重鬱症

Severe depressive disorder

4. 輕度攝護腺肥大合併中度排尿功能障礙

Mild benign prostate hypertrophy combined with moderate degree urinary dysfunction

【處置意見】

Managements

1. 神經退性化疾患，經神經內科醫師診治，以低劑量madopar治療，手抖情況穩定。步態不穩及漏尿 (使用尿布輔助) 仍有逐漸惡化的趨勢。經核磁共振造影及脊椎穿刺檢查後排除水腦的可能。上述症狀因屬退化性疾患的部份表徵，目前無有效的治療方式。

After the examinations and managements by neurologists, the hand tremor due to neurodegenerative disease has been improved via the treatment with low dose Madopar. However, the unsteady gait and urinary incontinence, assisted by diaper, are deteriorating. Magnetic resonance imaging and spinal tapping have excluded the possibility of hydrocephalus. The above-mentioned symptoms have no effective treatments at present because they are caused by degenerative diseases.

2.  阻塞型睡眠呼吸暫止症經手術後，103年5月份睡眠呼吸檢查結果顯示，對於睡眠的改善無明顯的效果，仍為重度睡眠呼吸障礙。

Polysomnographic sleep study, performed in May, 2014, showed that the obstructive sleep apnea syndrome has not improved after tonsillectomy and uvulopalatopharyngoplasty. The patient still has severe sleep apnea syndrome.

3.  重鬱症經多種抗憂鬱藥物及安眠藥治療，療效不佳且出現副作用，目前以lamictal為主要藥物治療。到目前為止，情緒狀態仍無明顯的改善，主要因心理上落差極大造成調適上的困難，以及監獄環境仍持續造成情緒上的壓力。

Despite the use of multiple anti-depressive medications and hypnotics, his severe depressive disorder persists without improvement. Some side effects of medication even appear. At present, his severe depression is treated mainly by Lamictal. So far, his emotional state shows no apparent improvement. The main reasons for the difficulty in mental adaptation are the great change from a president to a prisoner and the emotional stress caused by the environmental conditions in the jail.

4.  輕度攝護腺肥大合併排尿功能障礙，經兩線的藥物治療，仍無明顯的改善。漏尿問題經檢查後排除週邊泌尿系統的問題，主要應為中樞性神經性問題。因無明顯改善，目前已無泌尿系統藥物治療，建議持續追蹤。

Despite the use of two lines of medication, the mild prostate hypertrophy combined with urinary dysfunction still show no improvement. Urological examinations have excluded the possibility of disorders in the peripheral urinary system as the cause of his urinary incontinence, which implies that symptoms should have been caused by disorders in the central nerve system. Because of no improvement, no drugs for urinary system are prescribed. Continual monitoring of this condition is suggested.

5.  至目前為止，上述疾病對於治療的反應有限。綜合上述病情，病患須全日由看護協助照顧日常生活，不宜出庭應訊。以治療上的考量，離開目前監禁環境及居家療養，或其他可行的處置方式，較能有效改善目前病情。

Till now, the responses of his illnesses to the above-mentioned treatments are limited. Overall, the daily activities of the patient should be cared by full time caregivers. He should not go to any court proceedings. From medical point of view, the only effective treatments for the patient are: leaving the current prison conditions and returning home to receive family care, or other plausible ways of management.