Parkinson disease

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 are not sure why some people get Parkinson disease. In people with Parkinson disease, brain cells that produce the chemical messenger dopamine start to die. Dopamine send signals to 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 disease, being exposed to certain pesticides and herbicides, getting older, and lower levels of estrogen in women.

What to Expect at Your Doctor's Office

Since tests cannot positively identify Parkinson disease, your doctor may rely mostly on interviews with you and your family. Your doctor 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 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 disease, 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 disease. Doctors may try to wait to start drug therapy because the drugs tend to lose effectiveness over time. Among the drugs used are:

• Levodopa (L-dopa) and carbidopa. Are the main drugs used to treat Parkinson 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 awhile, 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), pramipexole (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 disease 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

DO NOT try to treat Parkinson disease with alternative therapies alone. Used with conventional medications, complementary and alternative therapies (CAM) may help provide some relief of symptoms and slow progression of the disease. Some CAM therapies may interfere with certain medications, so work with your physician to find the safest, most effective CAM therapies for you.

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 during the evening hours rather than morning and afternoon. DO NOT 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 prevent constipation, which is a common symptom of Parkinson disease.

Many supplements may interact with medications you take for Parkinson disease, or may work only at particular doses. DO NOT take any supplements, even vitamins, without your doctor's guidance.

• Coenzyme (CoQ10). 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 progression of Parkinson disease in the early stages. However, not all studies agree. CoQ10 can promote blood clotting, and 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 disease among people who are in the early stages, and who do not need medication to control symptoms. In another study, creatine did not work as well for people with advanced disease. Creatine may also help people with Parkinson disease get more benefit from resistance training. Tell your doctor about any kidney problems you may have before taking creatine.
• Vitamin C and vitamin E. In one study, high doses of these antioxidant vitamins helped delay the need for medication. 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, 3 times per day were able to lower their levodopa dose.
• Phosphatidylserine (PS). A substance made by the body that is important to brain function. People with Parkinson disease often have low levels of PS. One study showed that taking 100 mg of PS, 3 times per day improved mood and brain function in people with Parkinson disease and Alzheimer-type dementia. PS can interact with a number of drugs, including some that are taken to treat Parkinson disease. Ask your doctor before taking PS.
• NADH. NADH is the active form of vitamin B3, and helps raise levels of dopamine in the brain. Studies in Parkinson disease have shown mixed results, and some have used injections rather than oral doses.
• Vitamin D. People with Parkinson disease often have low levels of vitamin D. Taking a supplement can help prevent osteoporosis.
• Vitamin B6 (pyridoxine). Has been used to treat Parkinson disease, but it is controversial. Vitamin B6 can make some Parkinson disease medications less effective. Naturally-oriented physicians may use vitamin B6, 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 disease. Talk to your doctor about side effects from caffeine.
• Fava beans ((Vicia faba). Can have both good and bad effects in people with Parkinson 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 you have added them to your diet.
• Epigallocatechin-3 Gallate. This component of tea has powerful neuroprotective effects.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, or 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 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 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 to 67.5 g per day, divided in 2 to 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. If you take medication 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 disease. Studies suggest that it improves circulation to the brain, as well as improving mood, cognitive function, and general neurological function. But it has not been studied for Parkinson disease. If you are interested in brahmi, find a qualified Ayurveda practitioner, and do not take brahmi without informing all your prescribing doctors.

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 disease with restless legs at night.
• Mercurius vivus. For Parkinson disease 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 reduce tremors and improve function.

The following movement therapies may help people with Parkinson disease 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.
• Strength training. Studies show strength training improves mobility, fatigue, quality of life, and disease progression among people with Parkinson disease.

Tai chi, Qigong and yoga can improve balance, flexibility, and range of motion in people with Parkinson disease. They may also boost mood, and improve sleep.

Traditional Chinese Medicine (TCM) views disease as caused by internal imbalances. It has historically been used to treat Parkinson disease with acupuncture and individually prepared herbal remedies. One study showed that acupuncture improved symptoms in a small group of people with Parkinson disease. People with Parkinson disease may also find that acupuncture helps them sleep better. If you consult a TCM practitioner, make sure your doctor is aware of any suggested treatment.

Following Up

Since Parkinson disease gets worse as time goes on, you will need to be under constant medical care. Drug treatments often do not work as well over time, and you must keep a close eye on your symptoms.

Special Considerations

Exercise helps improve mobility. It is important to note the Parkinson disease patients with dementia are twice as likely to have insulin resistance. Conditions like depression and dementia are often diagnosed in this population, but not adequately treated.

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