Complementary and Alternative Therapies for Parkinson Disease

CONFERENCE REPORTER

Patients who have Parkinson disease may benefit from complementary and alternative therapies (CAM). These treatment therapies can help alleviate symptoms or slow down disease progression. It is estimated that approximately 40% of patients with Parkinson disease have used at least one type of CAM therapy.¹ Commonly used options for Parkinson disease including exercise, herbal remedies, and interventions such as acupuncture.

Each type of CAM therapy may have its own mechanism of action and outcomes, and while the effects of an individual type of CAM therapy on Parkinson disease may be examined on its own, they are often evaluated as a group. There are still many unanswered questions, however, about the mechanisms and effects of various CAM therapies. Findings indicate that some CAM therapies may have a promising future in the management of Parkinson disease.

Exercise

Several techniques, including Tai Chi, meditation, and yoga, have all been examined as CAM approaches for management of Parkinson disease. A recent meta-analysis identified 21 studies that assessed the effects of Tai Chi or Qigong on several aspects of Parkinson disease, including motor and non-motor function and quality of life.

In a report of the results of their meta-analysis, Song and colleagues² noted that there was heterogeneity among the different studies and observed mixed results in terms of motor outcomes, with little conclusion in terms of non-motor outcomes. While the researchers concluded that the exercises were safe, and that there were clinically relevant outcomes in favor of Tai Chi and Qigong for motor function, balance, and quality of life, they expressed the need for more rigorous studies.

Yoga and meditation, either together or separately, have not shown consistently reliable results pointing to efficacy in Parkinson disease. Kwok and colleagues,³ a research group in Hong Kong, are conducting a study that will be the first randomized trial to compare the effects of yoga with stretching and resistance training exercises in a PD population. Measured outcomes will include measures of psychological, physiological, and spiritual and health-related quality of life.

Herbal treatments

Herbal treatments have also been used for the management of Parkinson disease. Amro and colleagues⁴ evaluated the effect on Parkinson disease and the possible mechanism of action of several herbs, including Chunghyuldan (CHD) and Ginkgo biloba. They observed that CHD reduced bradykinesia and lowered dopaminergic neuronal damage in Parkinson disease models. Moreover, Ginkgo biloba might have antioxidant effects with the inhibition of oxidative stress in Parkinson disease.

While not a common choice for patients who have Parkinson disease, recent legalization of cannabis has resulted in increased medicinal use. Finseth and colleagues⁵ evaluated the use of several CAM therapies for Parkinson disease. Their findings indicate that 78% of patients who used cannabis for treatment of Parkinson disease reported non-specific improvement-the most notable symptomatic effects of cannabis were improved mood and sleep. The mechanism of action and whether there is a specific impact on the pathogenesis of Parkinson disease is unclear.

Acupuncture

Acupuncture and electro acupuncture have been used for treatment of Parkinson disease for a number of years but with mixed results. One controlled experiment compared sham acupuncture with real acupuncture for treatment of fatigue in Parkinson disease.⁶ The results showed that patients had improvement with both techniques-63% of patients reported noticeable improvement in their fatigue, and there were no significant between-group differences.

Proposed mechanisms of action

Some researchers have suggested that prevention of oxidative stress could play a role in the effects noted with CAM in Parkinson disease. Mucuna pruriens, which contains levodopa, may have a mechanism specific to Parkinson disease. It may be that general mechanisms such as placebo effects, stress reduction, and improved mood and sleep, are responsible for the observed effects.¹ Given the similarities in outcomes between different types of CAM treatment ranging from meditation to music to cannabis, this hypothesis makes sense.

Summary

At the International Congress of Parkinson’s Disease and Movement Disorders® in Hong Kong, Sujith Ovallath, MD, from India presents an Eastern perspective of CAM interventions for Parkinson disease, and Benzi Kluger, MD, MS, from the US presents the Western perspective. In his presentation, Sun Ju Chung, MD, PhD, from South Korea asks the question of why patients who have Parkinson disease are attracted to CAM.

References:

1. Ghaffari BD, Kluger B. Mechanisms for alternative treatments in Parkinson's disease: acupuncture, tai chi, and other treatments. Curr Neurol Neurosci Rep. 2014;14:451.

2. Song R, Grabowska W, Park M. The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson disease: a systematic review and meta-analysis. Parkinsonism Relat Disord. 2017;41:3-13.

3. Kwok JYY, Kwan JCY, Auyeung M, et al. The effects of yoga versus stretching and resistance training exercises on psychological distress for people with mild-to-moderate Parkinson disease: study prxotocol for a randomized controlled trial. Trials. 2017;18:509.

4. Amro MS, Teoh SL, Norzana AG, Srijit D. The potential role of herbal products in the treatment of Parkinson disease. Clin Ter. 2018;169:e23-e33.

5. Finseth TA, Hedeman JL, Brown RP 2nd, et al. Self-reported efficacy of cannabis and other complementary medicine modalities by Parkinson disease patients in Colorado. Evid Based Comp Alt Med. 2015;2015:847-849.

6. Kluger BM, Rakowski D, Christian M. Randomized, controlled trial of acupuncture for fatigue in Parkinson disease. Mov Disord. 2016;31:1027-1032.