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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 condition of the nervous system that affects movement and gets worse over time. Its symptoms -- tremors (often starting in one hand), slowed movement, rigidity -- are caused when nerve cells in the brain that make 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 usually affects people after age 60, but it may start as early as age 40. There is no cure for Parkinson's disease, but medications can help reduce the symptoms.

Signs and Symptoms

Symptoms can start very slowly 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, called bradykinesia
  • Slow blinking

Secondary symptoms may include:

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

What Causes It?

Researchers aren’t sure why some people get Parkinson’s disease. 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 often 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 often. 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 wait to start drug therapy, because the drugs tend to not work as well 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 there is more dopamine available for the brain. After a while, the benefits of levodopa tend to wear off faster and some people may have involuntary movements, called dyskinesia.
  • Dopamine agonists -- act like dopamine in the brain. They do not work as well as levodopa, but they last longer. They are often used along with levodopa. These drugs include ropinirole (Requip), rramipexole (Mirapex), and rotigotine (Neupro).
  • Selective monoamine oxidase type (MAO-B) inhibitors -- slow the breakdown of dopamine in the brain, meaning more of it stays available. They may help push back the time when you need to take 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 not much at breakfast or lunch. Don't go on a low-protein diet by yourself -- your doctor should watch 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 work only 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. CoQ10 can interact with blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. CoQ10 may lower blood pressure. If you take blood pressure medication, it could increase the risk of low blood pressure. It may also interact with some chemotherapy drugs.
  • 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, creatine did not work as well for people whose disease was more advanced, although they were able to have smaller increases in their medication doses. Creatine may also help people with Parkinson's get more benefit from resistance training. Tell your doctor about any kidney problems 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. Vitamin E supplements can increase the risk of bleeding, especially if you also take blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
  • 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. PS can interact with a number of drugs, including some that are taken to treat Parkinson's. Ask your doctor before taking PS.
  • 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.
  • Vitamin B6 (pyridoxine) has been used to treat Parkinson's disease, but it is controversial. Vitamin B6 can make some Parkinson's medications 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. Talk to your doctor about side effects from caffeine.
  • 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 more levodopa in their diet may help with symptoms. For others, it could cause an overdose. Talk to a qualified botanical prescriber before using fava beans, and make sure all your doctors know about adding them to your diet.

Herbs

Herbs are a 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) -- an antioxidant that improves blood flow to the brain and may help with dopamine delivery. Gingko interacts with many medications, including blood-thinners such as warfarin (Coumadin) and clopidogrel (Plavix). Do not take gingko without your doctor's supervision.
  • Cowhage (Mucuna pruriens) -- This herb contains levodopa. In one small study, it worked better 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. Cowhage can interact with other medications, including those taken for diabetes, antidepressants called MAOIs, and antipsychotics. It can also lower blood pressure, so if you take medications for high blood pressure you run the risk of your blood pressure dropping too low. Do not take cowhage without your doctor’s supervision, especially if you already take levodopa.
  • Brahmi (Bacopa monniera) -- an Ayurvedic herb that is sometimes 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. But it hasn't been studied for Parkinson's. If you're interested in brahmi, find a qualified Ayurveda practitioner, and do not take brahmi without the knowledge of all your prescribing doctors.

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 increase circulation and decrease 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 have better 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 boost mood.

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 in a small group of people with Parkinson's. Scalp acupuncture and acupuncture with electrical stimulation, in particular, have worked in some cases. People with Parkinson's may also find that acupuncture helps them sleep and rest better. 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 don't work as well over time, and you must keep a close eye on your symptoms.

Special Considerations

Exercise will also help you improve mobility.

Supporting Research

Barichella M, Cereda E, Pezzoli G. Major nutritional issues in the management of Parkinson's disease. Mov Disord. 2009 Oct 15;24(13):1881-92. Review.

Bender A, Koch W, Elstner M, et al. Creatine supplementation in Parkinson disease: a placebo-controlled randomized pilot trial. Neurology. 2006;67:1262-4.

Chen LW, Wang YQ, Wei LC, Shi M, Chan YS. Chinese herbs and herbal extracts for neuroprotection of dopaminergic neurons and potential therapeutic treatment of Parkinson's disease. CNS Neurol Disord Drug Targets. 2007 Aug;6(4):273-81. Review.

Earhart GM. Dance as therapy for individuals with Parkinson disease. Eur J Phys Rehabil Med. 2009 Jun;45(2):231-8. Review.

Hass CJ, Collins MA, Juncos JL. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson's disease: A randomized trial. Neurorehabil Neural Repair. 2007;21(2):107-15.

Hauser RA, Zesiewicz TA. Advances in the pharmacologic management of early Parkinson disease. Neurologist. 2007;13(3):126-32.

Joh TH, Park HJ, Kim SN, Lee H. Recent development of acupuncture on Parkinson's disease. Neurol Res. 2010 Feb;32 Suppl 1:5-9.

Katzenschlager R, Evans A, Manson A, et al. Mucuna pruriens in Parkinson's disease: a double blind clinical and pharmacological study. J Neurol Neurosurg Psychiatry. 2004;75:1672-77.

Lees A. Alternatives to levodopa in the initial treatment of early Parkinson's disease. Drugs Aging. 2005;22(9):731-40.

Nagashayana N, Sankarankutty P, Nampoothiri MRV, et al. Association of l-DOPA with recovery following Ayurveda medication in Parkinson's Disease. J Neurol Sci. 2000;176:124-7.

The NINDS NET-PD Investigators. A randomized clinical trial of coenzyme Q10 and GPI-1485 in early Parkinson disease. Neurology. 2007;68:20-8.

The NINDS NET-PD Investigators. A randomized, double-blind, futility clinical trial of creatine and minocycline in early Parkinson disease. Neurology. 2006;66:664-71.

Sheffield JK, Jankovic J. Botulinum toxin in the treatment of tremors, dystonias, sialorrhea and other symptoms associated with Parkinson's disease. Expert Rev Neurother. 2007;7(6)637-47.

Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. 2002;59:1541-50.

Yuan H, Zhang ZW, Liang LW, Shen Q, Wang XD, Ren SM, Ma HJ, Jiao SJ, Liu P. Treatment strategies for Parkinson's disease. Neurosci Bull. 2010 Feb;26(1):66-76.


Review Date: 4/9/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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