Parkinson's disease (PD)
Related Terms
Ablative, anticholinergic, body mass index, bradykinesia, cerebrospinal fluid, computerized tomography, constipation, cryothalamotomy, CT, DBS, deep brain stimulation, delusion, dementia, dopamine, dysarthia, dyskinesia, embryo, estrogen, globus pallidus, hallucination, hormonal replacement therapy, HRT, idiopathic, incontinence, laxative, magnetic resonance imaging, microphagia, movement disorder, MRI, nerve, neurological, neuron, obesity, pallidotomy, paralysis, paresis, parethesia, parkinsonism, restorative, rigidity, spinal tap, stem cell, stroke, substantia nigra, tardive dyskinesia, thalamotomy, transplantation, umbilical cord.
Background
Parkinson's disease (PD) is a movement disorder that is chronic and progressive, meaning that symptoms continue and worsen over time. PD affects nerve cells in a part of the brain that controls muscle movement.
PD occurs when a group of cells in an area of the brain called the substantia nigra begin to malfunction and die. The cells in the substantia nigra produce a chemical called dopamine. Dopamine is a neurotransmitter, or chemical messenger, that sends information to the parts of the brain that control movement and coordination. When an individual has PD, their dopamine-producing cells begin to die and the amount of dopamine produced in the brain decreases. Messages from the brain telling the body how and when to move are therefore delivered more slowly, leaving a person incapable of initiating and controlling movements in a normal way.
PD is the most common form of parkinsonism. Parkinsonism is a group of movement disorders that have similar features and symptoms. When the cause of PD is unknown, it is called idiopathic Parkinson's disease.
The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination (parkinsonian gait). As these symptoms become more severe, patients may have difficulty walking, talking, or completing other simple tasks.
Early symptoms of PD are subtle and occur gradually. In some people, the disease progresses more quickly than in others. As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.
PD usually affects people over the age of 50. According to the National Institute of Neurological Disorders and Stroke (NINDS), at least 500,000 people in the United States are estimated to have Parkinson's disease, and about 50,000 new diagnoses are made each year. The disorder occurs in all races but is somewhat more prevalent among Caucasians. Men are affected slightly more often than women.
Symptoms of PD may appear at any age, but the average age of onset is 60. It is rare in people younger than 30 and risk increases with age. It is estimated that 5-10% of patients experience symptoms before the age of 40.
Currently, there is a lack of blood or laboratory tests that have been proven to help in diagnosing PD. Therefore, the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose accurately. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.
Risk factors and causes
Age: Age is one of the main risk factors for Parkinson's disease (PD). Although the disease can rarely affect adults in their 20s, it ordinarily starts in middle or late life. The risk of developing PD continues to increase with age.
Heredity: Having one or more close relatives with PD increases the chances that the individual will also develop the disease. The risk of developing PD is still less than five percent if a relative has the condition.
Sex: Men are more likely to develop PD than women, possibly due in part to decreased levels of estrogen in men.
Exposure to pesticides and herbicides: Ongoing exposure to herbicides and pesticides puts an individual at slightly increased risk of developing PD. There is also an increased risk if the individual is involved in farming, lives in a rural area, or drinks well water. Local health departments can test well water for contaminants such as pesticides.
Reduced estrogen levels: Reduced estrogen levels may increase the risk of PD. Menopausal women who receive little or no hormone therapy (such as estrogen and progesterone) and those who have had hysterectomies may be at an increased risk for developing PD. Menopausal women using hormonal therapy appear to have a decreased risk, as do women taking birth control pills. However, taking hormonal therapy as a combination therapy (estrogen plus progestin) can increase the risk of serious side effects such as heart disease and cancer.
Medications: A number of drugs taken for long periods of time or in excessive dosages can cause symptoms of PD. These include medications such as haloperidol (Haldol?) and chlorpromazine (Thorazine?), which are prescribed for certain psychiatric disorders. Other medications used to treat nausea, such as prochlorperazine (Compazine?) and metoclopramide (Reglan?), may also cause symptoms of PD. The anti-seizure drug valproic acid (Depakene? or Depakote?) may cause some of the features of parkinsonism, especially severe tremor. These medications do not cause PD, and the symptoms of PD disappear when the drugs are stopped.
Signs and symptoms
Individuals with idiopathic (unknown cause) Parkinson's disease, or PD, may develop several symptoms over time, but they typically develop the primary symptoms- bradykinesia, tremor, rigidity, and parkinsonian gait, or manner of walking. Most individuals with PD do not develop all of the symptoms associated with the disease.
Primary symptoms:
Not every person with Parkinson's disease (PD) develops all signs or symptoms of the disease. Some individuals experience tremor as the primary symptom, while others may not have tremor but do have balance problems. The disease may progress quickly or gradually over years. Many people become profoundly disabled and others function relatively well.
Symptoms may vary from day to day or even moment to moment. There is no clear reason for the fluctuation of symptoms. Variance may be attributable to the disease process or to anti-parkinson medications.
Tremor: In the early stages of the disease, about 70% of individuals experience a slight tremor in the hand or foot on one side of the body, or less commonly in the jaw or face. It appears as a slight beating or pulsing movement in the cheek, face, or jaw. Because the Parkinson's tremor usually appears when an individual's muscles are relaxed, it is called resting tremor. The affected body part trembles when it is not doing work and it usually subsides when a person begins an action. The tremor often spreads to the other side of the body as the disease progresses, but remains most apparent on the original side of occurrence. Hand tremors are often referred to as a "pill rolling" motion, as if the individual is rolling a pill between the thumb and fingers.
Rigidity: Rigidity, also called increased muscle tone, means stiffness or inflexibility of the muscles. Muscles normally stretch when they move and then relax when they are at rest. In rigidity, the muscle tone of an affected limb is always stiff and does not relax, sometimes resulting in a decreased range of motion. An individual with rigidity may not be able to swing the arms when walking because the muscles are too tight. Rigidity can cause pain and cramping.
Bradykinesia: Bradykinesia is the phenomenon of an individual experiencing slow movement. In addition to slow movements, an individual with bradykinesia will probably also have incomplete movement, difficulty initiating movements and sudden stopping of ongoing movement. Individuals who have bradykinesia may walk with short, shuffling steps (called festination). Bradykinesia and rigidity can occur in the facial muscles, reducing an individual's range of facial expressions.
Impaired balance and coordination: Individuals with PD often experience instability when standing or impaired balance and coordination. These symptoms, combined with other symptoms such as bradykinesia, increase the probability of falling. Individuals with balance problems may have difficulty making turns or abrupt movements. They may go through periods of freezing, which is when the individual feels stuck to the ground and finds it difficult to start walking. The slowness and incompleteness of movement can also affect speaking and swallowing.
Secondary symptoms:
Secondary symptoms of PD can be, for many, as troublesome as the primary movement symptoms of the disease. Secondary symptoms include speech changes; loss of facial expression, or masking; micrographia or small, cramped handwriting; difficulty swallowing; drooling; pain; dementia or confusion; sleep disturbances; constipation; skin conditions such as boils or eczema; depression and anxiety; sexual dysfunction; urinary problems; a soft, whispery voice, termed hypophonia; fatigue or excessive tiredness; compulsive behavior; and cramping.
Diagnosis
Because no definitive tests exist for Parkinson's disease (PD), the condition can be difficult to diagnose, especially in the early stages. Signs and symptoms of Parkinson's disease, including gait changes, trembling, and trouble speaking or writing, may be generally thought of as the effects of aging, particularly in older adults with the disease. Parkinson's disease in younger adults may also be misdiagnosed by doctors due to the misconception that only older adults get the condition.
Medical history and physical examination: A diagnosis of PD is based on the individual's medical history, observations of signs and symptoms, and a neurological examination. As part of the medical history, a doctor will discuss past and present medical conditions, surgeries, and medications. The doctor will also discuss the family history of the individual to determine if heredity may play a role in developing PD.
The neurological examination includes an evaluation of walking, coordination, and simple tests for dexterity. A doctor may also notice subtle signs of parkinsonism, such as reduced facial expressions, a lack of gestures, or a subtle tremor when taking the medical history.
Diagnosis is based on symptoms and ruling out other disorders that produce similar symptoms.
An individual must have two or more of the primary symptoms, including tremor, rigidity, bradykinesia (resting tremor), and impaired balance and coordination. In many cases, this diagnosis is made after observing that symptoms have developed and become established over a period of time.
Imaging techniques: After a thorough medical history, physical, and neurological exam, the doctor may order a computerized tomography (CT) or magnetic resonance imaging (MRI) scan to determine if other criteria for a diagnosis of PD exists, such as ruling out a brain tumor or stroke (a lack of oxygen to the brain causing neurological damage) that produce parkinsonian symptoms.
Blood tests: Blood tests
may include a complete blood count (CBC), a creatine kinase test, and a DNA analysis (to determine if the disorder is genetic). In some cases, a cerebrospinal fluid (CSF) analysis also is performed.
Spinal tap: Cerebrospinal fluid (surrounds the brain and spinal cord) analysis involves performing a spinal tap or lumbar puncture. In this procedure, about two tablespoons of cerebrospinal fluid is drawn into a needle, which is inserted between two lumbar vertebrae. The fluid is then examined under a microscope. This procedure is usually performed in a hospital or clinic under local anesthesia, although general anesthesia can be used. Side effects include pain and tenderness in the area of puncture.
Complications
Depression and emotional disturbances: As many as half of the individuals with Parkinson's disease (PD) develop depression. In some cases, depression may occur months or even years before PD is diagnosed. Although physical limitations resulting from PD can be frustrating and stressful, depression in someone with PD isn't usually a reaction to physical disability. Instead, it more likely arises from underlying brain changes associated with the disease itself.
Dementia: In addition, some people with PD eventually develop dementia, a condition that can include memory loss, impaired judgment, and personality changes.
Other complications: Other complications of PD may include difficulty chewing and swallowing. In the later stages of the condition, the muscles used to swallow may be affected, making eating more difficult.
PD may also cause either urinary incontinence (difficulty controlling the urine flow) or urine retention (difficulty to urinate). Certain medications used to treat the disease, especially anticholinergic drugs (such as tolterodine or Detrol?), may also cause difficulty in urinating.
Many individuals with PD develop constipation because the digestive tract works more slowly. Constipation may also be a side effect of medications used to treat the disease. Studies have found that chronic (long-term) constipation may be a risk factor associated with the development of PD, but further research needs to be performed in this area.
Individuals with Parkinson's disease often have trouble falling asleep and may wake up frequently throughout the night.
Some individuals with PD may notice a decrease in libido or sexual desire. This may be caused by a combination of psychological and physical factors, or it may be the result of physical factors alone. Medications may also cause a decrease in libido, including antidepressant medications such as fluoxetine (Prozac?) or amitriptyline (Elavil?).
Treatment
There is no cure for Parkinson's disease (PD). Treatment for PD is built around medications to relieve the symptoms. The U.S. Food and Drug Administration (FDA) also has approved a surgically implanted device that lessens tremors. In some severe cases, brain surgery may offer the greatest benefit.
Medications:
Medication selection and dosage is tailored to the individual. The doctor considers factors such as severity of symptoms, age, and presence of other medical conditions. No two individuals will respond identically to a particular drug or dosage level, so this process involves experimentation, persistence, and patience. As the disease progresses, drug dosages may have to be modified and medication regimens changed.
Levodopa/Carbidopa: Sometimes a combination of drugs is given. Levodopa and carbidopa combined (Sinemet? and Sinemet CR?) are the main drug treatment for PD. Levodopa is rapidly converted into dopamine by enzymes in the body. Because PD is caused by too little dopamine, this increase helps balance the levels of dopamine, decrease symptoms such as bradykinesia (slow trembling) and rigidity, and, less effectively, reduce tremor. Levodopa is often ineffective in relieving problems with balance. Carbidopa helps decrease the metabolism of levodopa, thereby increasing the amount available for the brain. Side effects include nausea and vomiting (especially early in treatment), hypotension (low blood pressure), and dyskinesias (abnormal movements). Slow dosage adjustment and taking medication with food can reduce these effects. Using the lowest effective dose may prevent or delay the appearance of motor dysfunction. Levodopa may become ineffective over time. Depression, confusion, and visual hallucinations also may occur when using levodopa, especially in the elderly.
Dopamine agonists: Dopamine agonists mimic dopamine's function in the brain. They are used primarily as adjuncts to levodopa/carbidopa therapy. They can be used as monotherapy but are generally less effective in controlling symptoms. Side effects are similar to those produced by levodopa and include nausea, sleepiness, dizziness, and headache. Dopamine agonists include bromocriptine (Parlodel?), pramipexole (Mirapex?), ropinirole (Requip?), and rotigotine (Neupro?). The FDA approved rotigotine transdermal system (Neupro?) for the treatment of early PD in May 2007. Neupro?, which is a medicated patch that is applied to the skin once a day, provides the dopamine agonist rotigotine continuously over a 24-hour period. Redness and tenderness are common at the site of application on the body.
Amantadine: Amantadine (Symmetrel?) is an antiviral drug with dopamine agonist properties. It increases the release of dopamine. It is often used to treat early-stage Parkinson's disease, either alone, with an anticholinergic drug, or with levodopa. Generally, it loses its effectiveness within three to four months. Doctors may cycle individuals on and off amantadine. Side effects include spotting of the skin, edema, confusion, blurred vision, insomnia, and anxiety.
MAO-B inhibitors: Dopamine is oxidized by monoamine oxidase B (MAO-B). Selegiline (Carbex?) inhibits MAO-B, increasing the amount of available dopamine in the brain. MAO-B inhibitors boost the effects of levodopa. Side effects may include nausea, dizziness, abdominal pain, confusion, hallucinations, and dry mouth.
Anticholinergics: Anticholinergics reduce the overactivity of the neurotransmitter acetylcholine to balance the reduced dopamine levels. This class of drugs is most effective in the control of tremors and they are used in combination with levodopa. Anticholinergic drugs include benztropine mesylate (Cogentin?), diphenhydramine (Benadryl?), and trihexyphenidyl (Artane?). Side effects associated with anticholinergic drugs include dry mouth, blurred vision, constipation, and urinary retention.
COMT (catechol-O-methyl transferase) inhibitors: COMT inhibitors help increase levodopa therapy by inhibiting the COMT enzyme, which metabolizes levodopa before it reaches the brain. Inhibiting COMT increases the amount of levodopa that enters the brain. These drugs are only effective when used with levodopa. COMT inhibitors include entacapone (Comtan?) and tolcapone (Tasmar?). But because tolcapone has been linked to liver damage and liver failure, the drug is normally used only in people who are not responding to other therapies. Entacapone is a COMT inhibitor that shares some of the properties of tolcapone, but does not seem to cause liver problems. Entacopone is now combined with carbidopa and levodopa in a medication called Stalevo?. Side effects include vivid dreams, visual hallucinations, nausea, sleep disturbances, daytime drowsiness, headache, and dyskinesias (difficulty in performing movements).
Surgery:
Surgery is another method of controlling symptoms and improving quality of life when medication ceases to be effective or when medication side effects, such as jerking and dyskinesias (difficulty in performing movements), become intolerable.
Not every individual suffering from Parkinson's disease (PD) is a good candidate for surgery. Surgery has not been found to be effective in those who respond poorly to levodopa/carbidoopa. Only about 10% of Parkinson's patients are estimated to be suitable candidates. There are three surgical procedures for treating Parkinson's disease: ablative surgery, stimulation surgery or deep brain stimulation (DBS), and transplantation or restorative surgery.
Doctors will help individual's with PD to determine if surgery is appropriate for them. Seeking more than one opinion may be helpful.
Deep brain stimulation: Deep brain stimulation (DBS) involves a surgically implanted, battery-operated medical device (called a neurostimulator) used to deliver electrical stimulation to areas of the brain that control movement. The electrical charge blocks nerve signals that trigger abnormal movement. In DBS, an electrode (lead) is inserted through a small incision in the skull and is implanted in the targeted area of the brain. An insulated wire (extension) is then passed under the skin in the head, neck, and shoulder, connecting the lead to the neurostimulator, which is surgically implanted in the chest or upper abdomen. Side effects of deep brain stimulation include bleeding at the implantation site, depression, impaired muscle tone, infection, loss of balance, paresis (slight paralysis), dysarthia (slurred speech), and parethesia (tingling) in the head or the hands.
Ablative surgery: Ablative surgery locates, targets, and then ablates (destroys) the clearly defined area of the brain that produces chemical or electrical impulses that cause abnormal movements. In this surgery, a heated probe or electrode is inserted into the targeted area. The individual remains awake during the procedure to determine if the problem has been eliminated. A local anesthetic is used to dull the outer part of the brain and skull. The brain is insensitive to pain, so the individual does not feel the actual procedure. In some cases, it may be difficult to estimate how much tissue to destroy and the amount of heat to use.
This type of surgery involves either ablation in the part of the brain called the globus pallidus (called pallidotomy) or ablation of brain tissue in the thalamus (called thalamotomy). A related procedure, cryothalamotomy, uses a supercooled probe that is inserted into the thalamus to freeze and destroy areas that produce tremors.
Pallidotomy may be used to eliminate uncontrolled dyskinesia (difficulty in movement) and thalamotomy may be performed to eliminate tremor. These procedures are successful in approximately 75% of cases.
Cryothalamotomy uses a super-cooled probe that is inserted into the thalamus to freeze and destroy areas that produce tremors. Ablative surgery is safe and rarely causes complications such as affecting other areas of the brain.
Transplantation or restorative surgery: In transplantation (or restorative) surgery, dopamine-producing cells are implanted into the striatum. The cells used for transplantation may come from one of several sources, including the individual's own body, human embryos, and pig embryos.
Using cells from the individual's body has been unsuccessful so far because of an insufficient supply of dopamine cells and the inability of the implanted cells to survive.
To use fetal cells, between three and eight embryos are needed per procedure, and even under the most favorable conditions, 90% of transplanted cells do not survive. This procedure is only moderately effective in some patients and usually in those younger than age 60. Preliminary studies have shown that pig embryo cells do survive transplantation and have an effect on symptoms. Stem cells, primitive cells that can grow into nerve cells, are able to survive and reproduce. Once they grow as nerve cells, they can be transformed into dopamine-producing cells. Stem cells are obtained from discarded blood in a newborn's umbilical cord, the bone marrow of an adult, unused embryos from fertility clinics, or an aborted embryo. There is much controversy surrounding the use of stem cells.
Nutrition and lifestyle changes:
Proper diet and exercise is very important for individuals with movement disorders, including PD. In helping individuals to eat, caregivers should allow plenty of time for meals. Food can be cut into small pieces, softened, or pureed to ease swallowing and prevent choking. While some foods may require the addition of thickeners, other foods may need to be thinned. Dairy products, in particular, tend to increase the secretion of mucus, which in turn increases the risk of choking.
Some individuals may benefit from swallowing therapy, which is especially helpful if started before serious problems arise. Suction cups for plates, special tableware designed for people with disabilities, and plastic cups with tops can help prevent spilling. The individual's doctor can offer additional advice about diet and about how to handle swallowing difficulties or gastrointestinal problems that might arise, such as incontinence or constipation.
Maximizing physical activity is a goal in all movement disorders. Patients should perform daily activities to the extent possible. If they cannot, a regular exercise program or physical therapy may help condition them physically and teach them adaptive strategies. Because the disease, medications, and inactivity can lead to constipation, patients should consume a high-fiber diet, such as bran cereals, whole wheat bread, fresh vegetables, and brown rice. Dietary supplements, including psyllium and stimulant laxatives (such as bisacodyl or Dulcolax?), may be needed for constipation.
Although their coordination may be poor, individuals should continue walking, with assistance if necessary. Those who want to walk independently should be allowed to do so as long as possible. Careful attention should be given to keeping their environment free of hard, sharp objects to help ensure maximal independence while minimizing the risk of injury from a fall. Individuals can also wear special padding during walks to help protect against injury from falls. Some individuals have found that small weights around the ankles can help stability. Wearing sturdy shoes that fit well can help as well, especially shoes without laces that can be slipped on or off easily. Velcro shoes may help provide extra stability.
Speech therapy:
Some movement disorders, such as PD, can impair speech, affecting the ability of the individual to express complex thoughts. Speech therapy may improve the individual's ability to communicate and swallow. It is important for caregivers to understand that individuals with these movement disorders may not be communicating due to the disease and not due to a lack of sociability.
Social Activity: Unless and until the disease's progression prohibits it, people with movement disorders should participate in outside activities, socialize, and pursue hobbies and interests. These activities also give family members and caregivers valuable time for themselves.
Caregiver support:
Movement disorders confront individuals and their caregivers with many complex problems that must be dealt with for the life of the patient. While it may be emotionally difficult, it is important for patients and caregivers to make informed, carefully considered decisions regarding the future while the patient is capable of making his or her contribution to a planned course of action.
Physical therapy: According to the American Physical Therapy Association, the goal of physical therapy or physiotherapy is to improve mobility, restore function, reduce pain, and prevent further injury by using a variety of methods, including exercises, stretches, traction, electrical stimulation, and massage. Physical therapy has been reported useful in neurological disorders.
Integrative therapies
Note: Although there are a few clinical studies using integrative therapies for the treatment of Parkinson's disease (PD), there have been studies in other neurological disorders that may present with similar symptoms as PD. Listed below are integrative therapies that have been studied clinically in various movement disorders, including PD.
Good scientific evidence:
5-HTP: 5-HTP is the precursor for serotonin. Serotonin is the brain chemical associated with sleep, mood, movement, feeding, and nervousness. Cerebellar ataxia results from the failure of part of the brain to regulate body posture and limb movements. 5-HTP has been observed to have benefits in some people who have difficulty standing or walking due to cerebellar ataxia. However, current evidence is mixed. Further research is needed before a strong conclusion can be drawn.
Avoid 5-HTP if allergic or hypersensitive to it. Signs of allergy to 5-HTP may include rash, itching, or shortness of breath. Avoid with eosinophilia syndromes, Down syndrome, or mitochondrial encephalomyopathy. Use cautiously if taking antidepressant medications, 5-HTP receptor agonists, carbidopa, phenobarbital, pindolol, reserpine, tramadol, or zolpidem. Use cautiously with kidney insufficiency, HIV/AIDS (particularly HIV-1 infection), epilepsy, or with a history of mental disorders. Avoid if pregnant or breastfeeding.
Music therapy: Music therapy has been reported to improve symptoms in people with Parkinson's disease. Modest improvements were seen in symptoms including: motor coordination, speech intelligibility and vocal intensity, bradykinesia (slow movement), emotional functions, activities of daily living, and quality of life. Music therapy is generally known to be safe.
Zinc: Wilson's disease is an inherited disorder of copper metabolism characterized by a failure of the liver to excrete copper, which leads to its accumulation in the liver, brain, cornea, and kidney, with resulting chronic degenerative changes. Early research suggests that zinc treatment may be effective in the management of Wilson's disease. More well-designed trials are needed to confirm these early results.
Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
Unclear or conflicting scientific evidence:
Acupressure, Shiatsu: The practice of applying finger pressure to specific acupoints (energy points) throughout the body has been used in China since 2000 B.C. Shiatsu technique involves finger pressure at acupoints and along body meridians (energy lines). It can incorporate palm pressure, stretching, massaging, and other manual techniques. Shiatsu practitioners commonly treat musculoskeletal and psychological conditions, including neck/shoulder and lower back problems, arthritis, depression, and anxiety. Acupressure may benefit several measures of severity of Parkinson's disease. Preliminary clinical evidence from one small study with individuals with facial spasms reported improvement when using Shiatsu acupressure. Further study is needed before conclusion can be made.
Acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious, long-term complications have not been reported, according to available scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
Acupuncture: Aucupuncture has been reported to help relieve symptoms of some neurological disorders, including cerebral palsy, nerve damage, Parkinson's disease (characterized by fine muscle coordination and tremors), Tourette's syndrome (characterized by "tics"), and trigeminal neuralgia. More trials need to be performed.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with a history of seizures.
Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. Preliminary research suggests that Alexander technique instruction may improve fine and gross movements and reduce depression in patients with Parkinson's disease. Well-designed human trials are necessary.
Serious side effects have not been reported in the available literature. It has been suggested that the technique may be less effective with learning disabilities or mental illnesses. The Alexander technique has been used safely in pregnant women.
Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Injections of arginine have been proposed to help manage adrenoleukodystrophy (ALD), although most study results are inconclusive. Further research is needed to evaluate the use of arginine in ALD and other neurological conditions.
Avoid if allergic to arginine. Avoid with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinners, blood pressure drugs, antidiabetic drugs, or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease.
Ashwagandha:Ashwagandha (
Withania somnifera) is widely cultivated in India and the Middle East for its medicinal properties, and it is also found in parts of Africa. There is insufficient scientific evidence to determine if ashwagandha is a safe and effective treatment for Parkinson's disease.
Avoid if allergic or hypersensitive to ashwagandha products or any of their ingredients. Dermatitis (allergic skin rash) was reported in three of 42 patients in one ashwagandha trial.There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha and most do not report the doses or standardization/preparation used.Avoid with peptic ulcer disease. Ashwagandha may cause abortions based on anecdotal reports. Avoid if pregnant or breastfeeding.
Ayurveda: Ayurveda is a form of natural medicine that originated in ancient India more than 5,000 years ago. Ayurveda is an integrated system of techniques that uses diet, herbs, exercise, meditation, yoga, and massage or bodywork to achieve optimal health. There is evidence that the traditional herbal remedy
Mucuna pruriens may improve symptoms in Parkinson's disease and that it may offer advantages over conventional L-dopa preparations in the long-term management of the disorder. More studies are needed in this area.
Ayurvedic herbs should be used cautiously because they are potent, and some constituents may be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs may interact with other herbs, foods, and drugs. A qualified healthcare professional should be consulted before taking.
Belladonna: Belladonna has been used for centuries to treat many medical conditions. To date, human studies have shown a lack of benefit from belladonna in treating autonomic nervous system disorders.
Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (bell peppers, potatoes, eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive heart failure, stomach ulcers, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy, urinary retention, narrow angle glaucoma, psychotic illness, Sj?gren's syndrome, dry mouth, neuromuscular disorders, (such as myasthenia gravis), or Down syndrome. Avoid if pregnant or breastfeeding.
Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system) and how this relationship affects the preservation and restoration of health. Although there is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of Parkinson's disease, anecdotal reports suggest a positive impact on fine muscle coordination in some individuals. More clinical research is necessary.
Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data. Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with a risk of tumors or cancers.
Choline: Data regarding the effectivenses of choline in the treatment of Parkinson's disease is conflicting and inconclusive at this time.
Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
Chromium: Chromium is an essential trace element that exists naturally in trivalent and hexavalent states. Chromium has been studied for its protective benefits in Parkinson's disease and is included in antioxidant multivitamins. However, there is lack of scientific evidence in humans in this area. Additional research is needed.
Trivalent chromium appears to be safe because side effects are rare or uncommon. However, hexavalent chromium may be poisonous. Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
Coenzyme Q10: Coenzyme Q10, or CoQ10, is produced by the human body and is necessary for the basic functioning of cells. There is promising evidence to support the use of CoQ10 in the treatment of symptoms associated with Friedrich's ataxia and Parkinson's disease. Better-designed trials are needed to confirm early study results.
Allergic reactions have not been associated with Coenzyme Q10 supplements, although rash and itching have been reported rarely. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or if taking anticoagulants (blood thinners) or antiplatelet drugs, blood pressure drugs, blood sugar drgus, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.
Cowhage: Cowhage (
Mucuna pruriens) seeds have been used in traditional Ayurvedic medicine to treat Parkinson's disease. Traditional Ayurvedic medicine and preliminary evidence suggests that cowhage contains 3.6-4.2% levodopa, the same chemical used in several Parkinson's disease drugs. Cowhage treatments have yielded positive results in early studies. However, more research should be conducted to determine the treatment that is most effective.
Avoid if allergic or hypersensitive to cowhage (Mucuna pruriens), its constituents, or members of the Fabaceae family. Avoid with psychosis or schizophrenia. Use cautiously with diabetes or Parkinson's disease or if taking levodopa, dopamine, dopamine agonists, dopamine antagonists, or dopamine reuptake inhibitors. Use cautiously if taking monoamine oxidase inhibitors (MAOIs) or other antidepressants or anticoagulants (blood thinners). Avoid if pregnant or breastfeeding, as cowhage may inhibit prolactin secretion.
Creatine: There is currently not enough scientific information to make a firm conclusion about the use of creatine in Huntington's disease. High-quality studies are needed to clarify this relationship.
Numerous studies suggest that creatine may help treat various neuromuscular diseases and may delay the onset of symptoms when used with standard treatment. However, creatine ingestion does not appear to have a significant effect on muscle creatine stores or high-intensity exercise capacity in individuals with multiple sclerosis, and supplementation does not seem to help people with tetraplegia. Although early studies were encouraging, recent research reports no beneficial effects on survival or disease progression. Additional studies are needed to provide clearer answers.
It is unclear if creatine is helpful in patients with spinal cord injuries. Results from early studies have been mixed. Further studies are required before a firm conclusion can be made.
Avoid if allergic to creatine or if taking diuretics. Use cautiously with asthma, diabetes, gout, kidney disorders, liver or muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
DHEA: There is conflicting scientific evidence regarding the use of DHEA (dehydroepiandrosterone) supplements for myotonic dystrophy. Better research is necessary before a clear conclusion can be drawn.
Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders or if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
Dong quai: Dong quai (
Angelica sinensis), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. There is insufficient evidence to support the use of Dong quai as a treatment for nerve pain. High-quality human research is lacking.
Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is unknown. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae/Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance, or hormone-sensitive conditions (like breast cancer, uterine cancer, or ovarian cancer). Do not use before dental or surgical procedures. Avoid if pregnant or breastfeeding.
Feldenkrais Method?: The Feldenkrais Method? involves stretching, reaching, and changing posture in specific patterns. In some cases, it includes a form of massage. Patients who practice complementary alternative medicine methods have reported that the Feldenkrais Method?, as well as breathing therapy, massage, and relaxation techniques, helped improve symptoms of dystonia. Further data are needed before a firm conclusion can be made. There is currently not enough clinical evidence to determine if the Feldenkrais Method? is an effective treatment for cerebral palsy.
There is currently a lack of available scientific studies or reports of safety of the Feldenkrais Method?.
Ginseng: A clinical study found that patients with neurological disorders may improve when taking Asian ginseng (
Panax ginseng). This supports research findings that report
Panax ginseng improving cognitive function. More research is needed in this area.
Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
Kava: Kava beverages, made from dried roots of the shrub
Piper methysticum, have been used ceremonially and socially in the South Pacific for hundreds of years and in Europe since the 1700s. There is currently unclear evidence on the use of kava for Parkinson's disease. Kava has been shown to increase 'off' periods in Parkinson's patients taking levodopa and can cause a semicomatose state when given with alprazolam. Consult with a qualified healthcare professional before taking kava due to the risk of harmful side effects.
Avoid if allergic to kava or kavapyrones. Avoid with liver disease, a history of medication-induced extrapyramidal (the motor system related to the basal ganglia) effects, and chronic lung disease. Avoid if taking medications for liver disease or CNS depressants such as alcohol or tranquilizers. Avoid while driving or operating heavy machinery (may cause drowsiness). Use cautiously with depression or if taking antidpressants. Avoid if pregnant or breastfeeding.
L-carnitine: Although used traditionally for support of neurological conditions, one poorly designed preliminary clinical study reported that L-acetyl-carnitine (carnitine or L-carnitine) possesses neither efficacy nor toxicity towards the patients with Huntington disease. Further trials are required to determine is L-carnitine is beneficial in individuals with neurological disorders.
Early research on the use of carnitine for Rett's syndrome has produced promising results. However, additional research is needed before a firm conclusion can be made.
Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Massage:
Early evidence suggests a possible benefit of massage for cerebral palsy, Parkinson's disease, and spinal cord injuries. However, evidence is insufficient on which to base recommendations.
Avoid with bleeding disorders, low platelet counts, or if taking blood-thinning medications (such as heparin or warfarin/Coumadin?). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
Melatonin: Melatonin is a naturally occurring hormone that helps regulate sleep/wake cycles (circadian rhythm). Melatonin has been reported useful in neurological conditions including Parkinson's disease, periodic limb movement disorder, Rett's syndrome, and tardive dyskinesia (abnormal movements that can occur after long-term use of some older antipsychotic drugs). The use of melatonin in these conditions, however, is not supported by rigorous scientific testing. Better-designed research is needed to determine if melatonin is beneficial in individuals with neurological disorders.
Avoid melatonin supplementation in women who are pregnant or attempting to become pregnant. Use cautiously with bleeding disorders, seizure disorders, or if taking anticoagulants.
Moxibustion: Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi (energy). One small study reported treatment of trigeminal neuralgia with cupping to have a significant therapeutic effect. However, there is insufficient available evidence and more clinical studies are needed in this area.
Avoid with aneurysms, any kind of "heat syndrome," heart disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, or inflammatory conditions. Avoid areas with an inflamed organ, contraindicated acupuncture points, allergic skin conditions, ulcerated sores, or skin adhesions. Avoid over the face, genitals, head, or nipples. Avoid in patients who have just finished exercising or taking a hot bath or shower. Avoid if pregnant or breastfeeding. Use cautiously over large blood vessels and thin or weak skin. Use cautiously with elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.
Physical therapy: There is evidence for the use of physical therapy for nerve or neurological disorders such as cerebral palsy, Guillain-Barre Syndrome (GBS), and Parkinson's disease. Additional high-quality studies are needed.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help with problem solving. Supportive psychotherapy may or may not reduce the motor and vocal tics associated with Tourette's syndrome. More research needs to be done before conclusions can be made. Some forms of psychotherapy may evoke strong emotional feelings and expression.
Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. There is promising early evidence suggesting that internal Qi gong may help in the treatment of Parkinson's disease. However, the evidence is somewhat unclear, and further research is needed.
Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
Reiki: Reiki is a system of laying on of the hands that originated in as a Buddhist practice approximately 2,500 years ago. Human study suggests that reiki may have an effect on autonomic nervous system functions such as heart rate, blood pressure, or breathing activity, important in neurological disorders that may damage autonomic function, including neurological conditions. Large, well-designed studies are needed before conclusions can be drawn.
Reiki is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.
Rolfing? Structural Integration:Rolfing? Structural Integration involves deep tissue massage aimed at relieving stress and improving mobility, posture, balance, muscle function and efficiency, energy, and overall well being. Rolfing? Structural Integration may slightly improve movement in cerebral palsy patients. More studies are needed to confirm these possible benefits.
Rolfing? Structural Integration should not be used as the sole therapeutic approach to disease, and it should not delay the time it takes to speak with a healthcare provider about a potentially severe condition. Rolfing? Structural Integration is generally believed to be safe in most people. Avoid in patients taking blood thinners and in patients with broken bones, severe osteoporosis, disease of the spine or vertebral disks, skin damage or wounds, bleeding disorders, blood clots, tooth abscesses, acute disc problems, aneurysm, fever, recent scar tissue, connective tissue disease, cancer, and in patients who have just received cortisone shots or who are on chronic cortisone therapy. Use cautiously in patients with varicose veins or phlebitis, joint diseases, psychosis or bipolar disorder, severe kidney, liver, or intestinal disease, diabetes, menstruation, infectious conditions, colostomies, high blood pressure, and stenoses or strictures.
Safflower: In clinical research, safflower (
Carthamus tinctoria) decreased deterioration caused by Friedreich's ataxia. More high-quality studies with larger sample sizes are needed to establish safflower's effect on neurological conditions.
Avoid if allergic/hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunodepressants or pentobarbital. Use cautiously with diabetes, low blood pressure, liver problems, bleeding disorders, or skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.
Selenium: Studies have consistently shown that antioxidants may not have clinical benefits in motor neuron diseases, such as amyotrophic lateral sclerosis (ALS). Although the research thus far does not discourage selenium supplementation in patients, more research is needed to determine if selenium is an effective treatment for central nervous system disorders.
Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Community-based fitness programs, which include tai chi classes, may improve balance in patients with Parkinson's disease and may motivate individuals to participate in routine exercise. Additional research is warranted in this area.
Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
Taurine: Taurine may affect cellular hyperexcitability by increasing membrane conductance to potassium and chloride ions, possibly by altering intracellular (within the cell) availability of calcium. Study results suggest that taurine supplementation may result in improvements in myotonic dystrophy. Well designed clinical trials are needed.
Taurine is an amino acid, and it is unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously in patients with high cholesterol, low blood pressure, bleeding disorders, potential for mania, or epilepsy. Avoid consuming energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients before drinking alcohol or exercising. Use cautiously if pregnant or breastfeeding because taurine is a natural component of breast milk.
TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Several studies have reported benefits of TENS therapy in patients with trigyminal neuralgia (facial pain), hemiplegia/hemiparesis, and spinal cord injury. Additional research is needed before a firm conclusion can be drawn.
Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as neuropathy) or with seizure disorders. Avoid if pregnant or breastfeeding.
Therapeutic touch: Therapeutic touch (TT) practitioners hold their hands a short distance from the patient without actually making physical contact. The purpose of this technique is to detect the patient's energy field, allowing the TT practitioner to correct any perceived imbalances. There is some evidence that therapeutic touch may affect some properties of the central nervous system. However, further research is needed to examine whether therapeutic touch could have any effects on central nervous system disorders.
Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation and on body areas with cancer.
Vitamin B6: Vitamin B6 (pyridoxine) is required for the synthesis of the neurotransmitters serotonin and norepinephrine and for myelin formation. Pyridoxine deficiency in adults principally affects the peripheral nerves, skin, mucous membranes, and the blood cell system. In children, the central nervous system (CNS) is also affected. Major sources of vitamin B6 include cereal grains, legumes, vegetables (carrots, spinach, and peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Some prescription drugs called neuroleptics, which are used in psychiatric conditions, may cause movement disorders as an unwanted side effect. Vitamin B6 has been studied for the treatment of acute neuroleptic-induced akathisia (NIA, a neuromuscular disorder characterized by a feeling of "inner restlessness" or a constant urge to be moving) in schizophrenic and schizoaffective disorder patients. Preliminary results indicate that high doses of vitamin B6 may be useful additions to the available treatments for NIA, perhaps due to its combined effects on various neurotransmitter systems. Further research is needed to confirm these results.
There is also early evidence that pyridoxine supplementation may be of benefit in hyperkinetic cerebral dysfunction syndrome and tardive dyskinesia. Further research is needed before a recommendation can be made.
Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Avoid vitamin B6 products if sensitive or allergic to any of their ingredients. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Use cautiously if pregnant or breastfeeding.
Vitamin E: Vitamin E has been studied in the management of tardive dyskinesia (abnormal movements that can occur after long-term use of some older antipsychotic drugs) and Parkinson's disease, although the results of existing studies are not conclusive enough to form a clear recommendation. More research is needed.
Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid doses greater than the recommended daily level in pregnant women and breastfeeding women.
Yohimbe bark extract: The terms yohimbine, yohimbine hydrochloride, and yohimbe bark extract are related but not interchangeable. Yohimbine is an active chemical (indole alkaloid) found in the bark of the
Pausinystalia yohimbe tree. Yohimbine hydrochloride is a standardized form of yohimbine that is available as a prescription drug in the United States. It is theorized that yohimbine may improve orthostatic hypotension (lowering of blood pressure with standing) or other symptoms of autonomic nervous system dysfunction. However, yohimbe bark extract may not contain significant amounts of yohimbine, and therefore may not have these proposed effects. More research is needed before a recommendation can be made.
Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease, or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders, or schizophrenia. Avoid use in children or in pregnant or breastfeeding women.
Fair negative scientific evidence:
Choline: Choline is possibly ineffective when taken by mouth for treating cerebellar ataxia. More research is needed in this area.
Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
Coenzyme Q10: There is negative evidence from studies that used coenzyme Q10 in the treatment of Huntington's disease. More studies are needed to confirm these results.
Allergy associated with coenzyme Q10 supplements has not been reported in the available literature, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution if history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix?), blood pressure, blood sugar, cholesterol or thyroid drugs. Avoid if pregnant or breastfeeding.
Creatine: Overall, the evidence suggests that creatine supplementation may not offer benefit to individuals with amyotrophic lateral sclerosis (ALS).
Avoid if allergic to creatine or if taking diuretics. Use cautiously with asthma, diabetes, gout, kidney disorders, liver or muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
Octacosanol: Policosanol is a mixture of very long chain alcohols that is purified from sugar cane wax. About 67% of policosanol is octacosanol. Although some research has been conducted using policosanol, little research is currently available that focuses on octacosanol alone. Early study does not show any evidence of benefit in brain or lung symptoms of amyotropic lateral sclerosis (ALS) patients. Additional study is needed in this area.
Avoid if allergic or hypersensitive to octacosanol or policosanol. Use cautiously if taking nitrates, lipid-lowering agents, cholesterol absorption inhibitors, nutraceuticals, aspirin, or agents that lower blood pressure. Avoid if pregnant or breastfeeding.
Prevention
Proper diet: It is best to avoid stimulants, alcohol, and smoking.
It may be best to eliminate potential food allergens, including dairy (e.g. milk, cheese, and sour cream), eggs, nuts, shellfish, wheat (gluten), corn, preservatives, and food additives (such as dyes and fillers). A clinical study found a higher risk of Parkinson's disease (PD) among dairy product consumers in both men and women, suggesting that dairy consumption may increase the risk of PD, particularly in men. Dairy may increase mucous production. More studies are needed.
Studies suggest that moderate consumption of coffee may actually help reduce the chances of developing PD. Research suggests it is the caffeine content that offers protection, so decaffeinated coffee may offer no benefits in PD prevention.
Preventing complications of PD, such as inability to swallow foods, is important. Food can be cut into small pieces, softened, or pureed to ease swallowing and prevent choking. While some foods may require the addition of thickeners, other foods may need to be thinned. Dairy products, in particular, tend to increase the secretion of mucus, which in turn increases the risk of choking.
Weight control: Body mass index is associated with a risk of Parkinson disease. Losing weight may reduce the chances of developing PD.
Exercise: Maintaining physical fitness is important to those suffering from movement disorders such as PD. Those with movement disorders who exercise and keep active tend to do better, with less symptoms and a slower disease progression, than those who do not. A daily regimen of exercise can help the person feel better physically and mentally. Individuals should walk as much as possible, even if assistance is necessary. Talking with a healthcare provider about an exercise program is important.
Mobility: PD can cause the sense of balance to be off, making it difficult to walk with a normal gait or stride. If shuffling of the feet is noticed, slow down and check the posture. It is best to stand up straight with the head over the hips and the feet eight to ten inches apart. It can also help to purchase a good pair of walking shoes. If the individual becomes frozen in place, rocking gently from side to side may help decrease the time of inability to move.
In the later stages of the disease, the individual may fall more easily. PD may affect the balance and coordination centers in the brain. In fact, a person may be thrown off balance by just a small push or bump. The following suggestions may help:
Wearing rubber-soled shoes is recommended by healthcare professionals. This type of shoe is less likely to slip than are shoes with leather soles. Rugs should be removed from the home to avoid tripping and falling. Carpeting should be secured firmly to the floor. It is recommended that handrails be installed, especially along stairways and in the bathroom, and that electrical and telephone cords be kept out of the way.
Daily activities:
Dressing can be the most frustrating of all activities for someone with PD. The loss of fine motor control makes it hard to button and zip clothes, and even to step into a pair of pants. A physical therapist can point out techniques that make daily activities easier. It is best to allow plenty of time so as not to feel rushed when dressing. Clothing may be laid nearby for ease of putting them on. Clothes that can be slipped on easily, such as sweat pants and t-shirts, simple dresses, or pants with elastic waistbands are recommended.
Even in the early stages of PD, the voice may become very soft or hoarse. To communicate more easily, healthcare professionals recommend facing the individual and deliberately speaking louder than necessary. Practicing reading or reciting out loud, focusing on breathing, and a strong voice may be beneficial. A speech pathologist may be consulted to improve verbal communication skills in individuals with PD.
Author information
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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