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Telemedicine Consultation Form

Multifocal Motor Neuropathy

Please complete the following Clinical form if you wish to be treated for Multifocal Motor Neuropathy.

Please review the Further Details Of Throne’s Stem Cell Treatment For Autoimmunity page at this link prior to submitting your request for Telephone Consultation since it will answer many of your general questions and allow us to focus on your specific questions during that consultation.

Clinical History Form - Multifocal Motor Neuropathy

If you wish to be considered for treatment of Multifocal Motor Neuropathy (MMN), please submit the following information

Your Gender

General Health

Do You Have Any Of These Other Autoimmune Disorders? Check All That Apply:

Multifocal Motor Neuropathy History

Has your MMN been diagnosed by a neurologist?
Have you been tested for anti-GM1 ganglioside antibodies?
Have you had motor nerve conduction studies?
Have you had sensory nerve conduction studies?
Do you have slowly progressive, focal, asymmetric limb weakness, that is, motor involvement in the motor nerve distribution of at least two nerves, for at least 1 month (usually more than 6 months)?
Do you have predominant upper limb involvement?
Do you have decreased or absent tendon reflexes in the affected limb?
Do you have absence of cranial nerve involvement?
Do you have cramps and fasciculations in the affected limb?
Have your symptoms improved with other immunomodulatory treatment(s)?
Do you have hyperactive tendon reflexes?
Do you have marked difficulty with speech or swallowing?
Do you have sensory impairment more marked than minor vibration loss in the lower limbs?
Did you have diffuse symmetric weakness during the initial weeks?
Has your MMN been treated with intravenous immunoglobulin?
Has your MMN improved with intravenous immunoglobulin treatment?

Social History

Are You Employed At This Time?
Do You Have Or Need A Caretaker And, If So, Who Supplies That Care?

DISCLAIMER: Throne Biotechnologies Stem Cell Educator Therapy is experimental and is not approved by the U.S. Food and Drug Administration for the treatment of Post-COVID Syndrome.

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