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Parkinson's disease

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Parkinson's disease is a progressive disorder of the central nervous system. Nerve cells in the brain that control movement deteriorate and die, causing problems with movement, especially tremors in the hands and rigidity in the face. The disease affects men and women equally, primarily after age 60. However, approximately 10% of people with the disease are under age 40. Symptoms become worse over time, although the disease usually progresses gradually. No cure is available, but drug therapy can help alleviate the symptoms.

Signs and Symptoms

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

Secondary symptoms may include the following.

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

What Causes It?

The cause of Parkinson's disease is unknown. The disease, however, is characterized by loss of brain cells that produce the neurotransmitter (brain chemical) dopamine, which affects muscle activity. Risk factors include having a relative with Parkinson's, being exposed to certain pesticides and herbicides, age, and reduced levels of estrogen in women.

What to Expect at Your Provider's Office

Since no test can positively identify Parkinson's, your health care provider will rely largely on interviews with you and your family. Your health care provider may order brain scans to measure dopamine activity. Genetic testing may help identify a specific illness (like Huntington's disease) linked to the disease.

Treatment Options

Exercise, especially intensive exercise, has been shown to improve symptoms and help maintain balance and mobility. Walking, swimming, jogging, or even dancing can be beneficial. Because people with Parkinson's 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. It is quite common for your health care provider to change medications and adjust dosages. Certain drugs used for the treatment of other diseases, especially glaucoma, heart disease, and high blood pressure, can influence the treatment of 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, which increase amounts of dopamine in the brain. With long-term use, the period where the drug is effective gets shorter (wearing off effect), and some people may experience involuntary movements, called dyskinesia.
• Dopamine agonists, which mimic the effects of dopamine in the brain
• Selegiline (Eldepryl), which delays the breakdown of dopamine and increases the effectiveness of levodopa and carbidopa
• Catechol-O-methyltransferase (COMT) inhibitors, which block an enzyme that breaks down dopamine
• Amantadine, which improves muscle control and lessens stiffness

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

Complementary and Alternative Therapies

Alternative therapies may 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 people who take these drugs are advised to control their intake of protein, and eat most protein in the evening and very little at breakfast or lunch. Your doctor should monitor your diet to make sure you get enough nutrients. In addition, a fiber supplement may help avoid constipation, which is a common symptom of Parkinson's.

Because 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. Several studies suggest that supplementing with coenzyme Q10 (1,200 mg per day), a substance made by the body that helps cells get energy from oxygen, can slow the progress of Parkinson's, especially in the early stages.
• In one study, high doses of antioxidants vitamin C (1,000 mg three times a day) and vitamin E (800 IU four times per day) helped postpone the need for drug therapy. But taking vitamin E alone did not seem to have the same effect. More studies are needed to confirm the benefits.
• Cytidinediphosphocholine or CDP-choline is another substance that is made in the body that appears to increase dopamine levels. In one study, people who took 400 mg three times per day were able to lower their levodopa dose.
• L-tyrosine is an amino acid that coverts to levodopa in the body. One preliminary study showed good results with 45 mg per pound of body weight as a dose, but needs to be confirmed. L-tyrosine should not be taken with levodopa.
• L-methionine (5 g per day), another amino acid, may also reduce some symptoms, but may interfere with the action of levodopa.
• Phosphatidylserine (PS), a phospholipid, is made by the body and 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.
• Omega-3 fatty acids (1 tbs. per day or 1,000 mg one to two times per day), such as those found in fish oil, help maintain neurological health. High doses can have a blood-thinning effect, so make sure all prescribing doctors are aware that it is being used.
• NADH (5 mg per day), the active form of vitamin B3, 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.
• Glutathione, an antioxidant produced by the body, has been given as a supplement intravenously to reduce symptoms. The treatment is controversial, however, because evidence for its effectiveness is lacking.
• Vitamin D (400-1,000 IU ) is often deficient in people with Parkinson's. Supplements can be helpful in preventing osteoporosis.
• S-adenosylmethionine or SAMe (400 - 1,600 mg per day) occurs naturally in the body and may be lowered by taking levodopa. SAMe may be effective in treating depression in people with Parkinson's. Long-term use, however, might decrease the effectiveness of levodopa.
• Vitamin B6 (pyridoxine) has been used to treat Parkinson’s disease, but not without some controversy. Vitamin B6 can actually interfere with the metabolism of certain Parkinson’s medications and make them less effective. Some naturally oriented physicians have used vitamin B6 specifically for this reason, to reduce the side effects of these medications. If your doctor suggests such an approach, the treatment should only be done by prescription and with the knowledge of all prescribing doctor.
• Fava beans ( Vicia faba ) can have both beneficial and harmful effects in people with Parkinson’s. Fava beans contain levodopa. Some additional levodopa from a dietary source may help some patients, while in others it may cause a dangerous 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 get your problem diagnosed 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 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Ginkgo (Ginkgo biloba) is an antioxidant that improves blood flow to the brain and may help with dopamine delivery (as a supplement 80 mg two times per day).
• Cowhage (Mucuna pruriens) 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.
• Brahmi ( Bacopa monniera ) is an Ayurvedic herb that is often used to treat people with Parkinson’s. Studies have pointed to its effectiveness as an antioxidant for the brain and suggest that it improves circulation to the brain, as well as improving mood, cognitive function, and general neurological function. Dosage guidelines vary among practitioners, but 100 - 200 mg twice daily is often recommended.

Homeopathy

Usually, the dose is three to five pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms get better. Because Parkinson's is a complex disease, you should consult a trained homeopath who can determine the appropriate remedy and change it as often as symptoms change.

• Argentum nitricum for ataxia (loss of muscle coordination), trembling, awkwardness, painless paralysis
• Causticum for Parkinson's with restless legs at night, contractures
• 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: A recent 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. If you consult a traditional Chinese medicine practitioner, make sure your doctor is aware of any suggested treatment.

Following Up

Since Parkinson's disease advances with time, 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.

Supporting Research

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:328-329.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:138.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:32-33, 111-113, 244-247, 303-304, 401-403.

Parkinson's Disease Foundation. Accessed at http://www.pdf.org/ on January 16, 1999.

Perry TL, Godin DV, Dansen S. Parkinson's disease: a disorder due to nigral glutathione deficiency. Neurosci Lett. 1982;33:305-310.

Russo A, Izzo AA, Borrelli F, Renis M, Vanella A. Free radical scavenging capacity and protective effect of Bacopa monniera L. on DNA damage. Phytother Res . 2003 Sep;17(8):870-5.

Tierney LM Jr, McPhee SJ, Papadakis MA. Current Medical Diagnosis & Treatment 1999. 38th ed. Stamford, Conn: Appleton & Lange; 1999.

Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing; 1988:346-349.

• Review Date: 9/1/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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