Introduction:

Parkinson's disease is a progressive disorder of the central nervous system, meaning symptoms get worse over time. Its symptoms -- tremors (often starting in one hand), slowed movement, rigidity -- are caused when nerve cells in the brain that produce a chemical called dopamine start to break down and die. Dopamine is a neurotransmitter, or messenger, that sends messages to the parts of the brain that control movement. Parkinson' s disease affects men and women equally, usually after age 60. About 10% of people with the disease are under age 40. No cure is available, but drug therapy can help reduce the symptoms.

Signs and Symptoms:

Symptoms can start very gradually and not be noticed for years. Often they start on one side of the body.

• Tremor, often beginning with a mild shaking in the hand
• Loss of balance
• Stiffness and rigid limbs
• Walking problems
• Slow movement (bradykinesia)
• Not blinking

Secondary symptoms may include the following:

• Memory loss
• Constipation
• Sleep disturbances
• Dementia
• Speech, breathing, swallowing problems
• Stooped posture

What Causes It?:

Researchers aren' t sure why some people get Parkinson' s. In people with Parkinson' s, brain cells that produce the chemical messenger dopamine start to die. Dopamine send signals to the areas of the brain that deal with muscle activity and movement. The brain starts to lose the ability to tell the body when and how to move. Risk factors include having a relative with Parkinson's, being exposed to certain pesticides and herbicides, getting older, and lower levels of estrogen in women.

What to Expect at Your Provider's Office:

Because no test can positively identify Parkinson's, your health care provider may rely mostly on interviews with you and your family. Your health care provider may order brain scans to measure dopamine activity. Tests may be needed to rule out other conditions that cause similar symptoms.

Treatment Options:

Exercise, especially intensive exercise, has been shown to improve symptoms and help maintain balance and mobility. Walking, swimming, jogging, or even dancing may help. Because people with Parkinson's disease have low levels of vitamin D, they are at risk of osteoporosis. Lifting weights can help reduce that risk. Your doctor may recommend an exercise program for you.

Drug Therapies

Several drugs treat the symptoms of Parkinson's, but they do not cure the disease. Your doctor may change medications and adjust dosages frequently. Certain drugs used for the treatment of other diseases, especially glaucoma, heart disease, and high blood pressure, may also be used to help treat Parkinson's disease. Sometimes doctors may try to delay drug therapy, because the drugs tend to become less effective over time. Among the drugs used are:

• Levodopa (L-dopa) and carbidopa -- are the main drugs used to treat Parkinson' s disease. Levodopa is converted to dopamine in the body. Carbidopa helps slow down how fast levodopa is converted to dopamine in the body outside the brain, meaning more dopamine is available to the brain. After a while, the benefits of levodopa tend to wear off faster and some people may experience involuntary movements, called dyskinesia.
• Dopamine agonists -- mimic the effects of dopamine in the brain. They are not as effective as levodopa, but they last longer. They are often used along with levodopa. These drugs include:
  • Ropinirole (Requip)
  • Pramipexole (Mirapex)
  • Rotigotine (Neupro)
• Selective monoamine oxidase type (MAO-B) inhibitors -- slow down how fast dopamine is metabolized in the brain, meaning more of it stays available. They may delay the introduction of levodopa by about 9 months.
• Catechol-O-methyltransferase (COMT) inhibitors -- boost the amount of levodopa that reaches the brain by blocking an enzyme that breaks down levodopa.
• Anticholinergic drugs -- help control symptoms like tremors. These drugs are used along with levodopa.
• Amantadine -- increases the release of dopamine in the brain and improves muscle control and lessens stiffness. It is used to treat early-stage Parkinson' s and often becomes less effective after a few months.

Psychotherapy can help you cope with associated conditions such as depression. Speech, physical, and occupational therapy may help.

Complementary and Alternative Therapies

Don' t try to treat Parkinson' s disease with alternative therapies alone. Used with conventional medications, alternative therapies may help provide some relief of symptoms and slow progression of the disease.

Nutrition and Supplements

A low protein diet helps the body use levodopa and carbidopa most efficiently, so your doctor may suggest that you limit the protein you eat, and eat most protein in the evening and little at breakfast or lunch. Your doctor should monitor your diet to make sure you get enough nutrients. A fiber supplement may help avoid constipation, which is a common symptom of Parkinson's.

Many supplements may interact with medications you take for Parkinson's, or may only be effective at particular doses. Do not take any supplements, even vitamins, without your doctor's guidance.

• Coenzyme Q10 (300 - 2400 mg per day) -- Some studies suggest that taking high doses of CoQ10, a substance made by the body that helps cells get energy from oxygen, may slow the progress of Parkinson's in the early stages. However, not all studies have found that it works.
• Creatine -- Some studies suggest that taking creatine, an amino acid that helps supply energy to muscles, may help slow progression of Parkinson' s among people who are in the early stages and do not need to take medications to control symptoms. In another study, people whose disease was more advanced did not get the same benefit, although they were able to have smaller increases in their doses of medications. Creatine may also strengthen the benefits of resistance training in people with Parkinson' s. Tell your doctor about any kidney issues you may have before taking creatine.
• Vitamin C (1,000 mg three times a day) and vitamin E (800 IU four times per day) -- In one study, high doses of these antioxidants vitamins helped postpone the need to take medications. But taking vitamin E alone did not seem to have the same effect. More studies are needed to know whether there is any real benefit.
• Cytidinediphosphocholine, or CDP-choline -- another substance made in the body that seems to increase dopamine levels. In one study, people who took 400 mg three times per day were able to lower their levodopa dose.
• Phosphatidylserine (PS) -- is a substance made by the body that is important to brain function. People with Parkinson's often have low levels of PS. One study showed that taking 100 mg of PS three times per day improved mood and brain function in people with Parkinson's and Alzheimer' s-type dementia.
• NADH (5 mg per day) -- NADH is the active form of vitamin B3 and helps raise levels of dopamine in the brain. But studies in Parkinson's disease have shown mixed results, and some have used injections rather than oral doses.
• Vitamin D (400 - 1,000 IU) -- People with Parkinson' s disease often have low levels of vitamin D. Taking a supplement can help prevent osteoporosis.
• S-adenosylmethionine or SAMe (400 - 1,600 mg per day) -- occurs naturally in the body and may be lowered by taking levodopa. One study found that SAMe may help treat depression in people with Parkinson's. Long-term use, however, might decrease the effectiveness of levodopa. Don' t use SAMe without talking to your doctor.
• Vitamin B6 (pyridoxine) has been used to treat Parkinson's disease, but not without some controversy. Vitamin B6 can interfere with the metabolism of certain Parkinson's medications, making them less effective. Some naturally oriented physicians have used vitamin B6 for that very reason, to reduce the side effects of these medications. If your doctor suggests such an approach, the treatment should be done only by prescription and with the knowledge of all prescribing doctors.
• Coffee and caffeine may lower the risk and progression of Parkinson's.
• Fava beans (Vicia faba) can have both good and bad effects in people with Parkinson's disease. Fava beans contain levodopa. For some people, getting additional levodopa in their diet may be helpful; for others, it could cause an overdose. Consult a qualified botanical prescriber before using fava beans, and make sure all prescribing doctors know about adding them to your diet.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day. You may use tinctures alone or in combination as noted.

• Ginkgo (Ginkgo biloba) 80 mg two times per day -- an antioxidant that improves blood flow to the brain and may help with dopamine delivery.
• Cowhage (Mucuna pruriens) -- This herb contains levodopa. One small study showed that it had better results than the form of levodopa given as prescription medication. Doses ranged from 22.5 - 67.5 g per day divided in 2 - 5 doses. More studies are needed. Do not take cowhage without your doctor' s supervision, especially if you already take levodopa.
• Brahmi (Bacopa monniera) -- an Ayurvedic herb that is often used to treat people with Parkinson's. Studies suggest that it improves circulation to the brain, as well as improving mood, cognitive function, and general neurological function. Dosage guidelines vary, but some practitioners suggest 100 - 200 mg twice daily.

Homeopathy

Consult a trained homeopath who can determine the right remedy for you and change it when your symptoms change.

• Argentum nitricum -- for ataxia (loss of muscle coordination), trembling, awkwardness, painless paralysis
• Causticum -- for Parkinson's with restless legs at night
• Mercurius vivus -- for Parkinson's that is worse at night, especially with panic attacks
• Plumbum metallicum -- especially with arteriosclerosis
• Zincum metallicum -- for great restlessness, and depression

Massage

May help with increasing circulation and decreasing muscle spasm. Cranio-sacral therapy, an osteopathic form of body work that focuses on the brain and spinal column, may decrease tremors and improve function.

Movement Therapies

May help people with Parkinson's improve motor skills and balance, and help them walk better.

• Music therapy: One study showed symptoms improved with music and dance therapy compared to physical therapy.
• Alexander Technique: emphasizes posture and balance. May help improve mobility and gait.
• Feldenkrais Method: aims to re-educate the body about movements that are difficult. May improve gait.

Mind-Body Therapies

Tai chi and yoga can improve balance, flexibility, and range of motion in people with Parkinson's disease. They may also improve emotional well-being.

Traditional Chinese Medicine and Acupuncture

Traditional Chinese Medicine views disease as caused by internal imbalances. It has historically been used to treat Parkinson's with acupuncture and individually prepared herbal remedies. One study showed that acupuncture improved symptoms significantly in a small group of people with Parkinson's. In particular, scalp acupuncture and acupuncture with electrical stimulation have shown positive results in some cases. People with Parkinson's may also get sleep and rest benefits from acupuncture. If you consult a Traditional Chinese Medicine practitioner, make sure your doctor is aware of any suggested treatment.

Following Up:

Since Parkinson's disease gets worse as time goes on, you will need to be under constant medical care. Drug treatments often become less effective over time, and you must keep a close eye on your symptoms.

Special Considerations:

Exercise will also help you improve mobility.