Natural remedy for parkinson

Contents

Home Remedies to Help With Parkinson’s Symptoms

Parkinson’s disease can make daily life very difficult, but simple do-it-yourself home remedies that help treat Parkinson’s symptoms can make living with the condition easier.

The muscle stiffness, weakness, and tremors of Parkinson’s can interfere with everyday activities, especially as the disease progresses. And Parkinson’s medications can cause distorted and involuntary movements, a side effect known as dyskinesia. Simple tasks like dressing, bathing, or even walking around the house can become frustrating.

Exercise is an essential part of managing the symptoms of the disease, notes the Michael J. Fox Foundation for Parkinson’s Research. Swimming, yoga, dance, and walking can help your muscles stay limber when you have Parkinson’s.

“Exercise is being researched as a possible intervention and possible neuro protective measure,” explains Linda Pituch, a patient services manager for the Parkinson’s Disease Foundation. “It’s not conclusive, but exercise may end up being viewed in the same vein as medication — a treatment you don’t skip.”

Stretching to Loosen Stiff Muscles of Parkinson’s

The following stretching and flexibility exercises can help to relieve stiff muscles, improve flexibility, and make everyday tasks easier:

  1. Stand facing a wall, about 8 inches away and reaching your arms upward. Place your hands on the wall for balance and stretch out your arms and back.
  2. Place your back against a wall for support and briskly march in place, lifting your knees as high as possible.
  3. Sit in a chair with a high, straight back and stretch your arms behind it, bringing your shoulders back as far as you can. As you stretch, lift your head toward the ceiling.
  4. Sitting in a chair, stomp your feet up and down while pumping your arms back and forth at your sides.

A Lower Protein Diet to Help Meds Work Better

Your diet can impact how well your medication helps to manage common Parkinson’s symptoms, including tremors (involuntary shaking) and constipation.

Diets heavy in protein, for instance, can limit your body’s absorption of levodopa in Sinemet, a common medication used in the management of Parkinson’s disease. As a result, some doctors recommend that people with Parkinson’s limit protein intake to 12 percent of their total daily calories. And taking your medication on an empty stomach before your meals can help your body absorb the drug, notes the Parkinson’s Disease Foundation.

The Michael J. Fox Foundation recommends avoiding certain foods because of possible medication interactions, including:

  1. Cured, fermented, or dried meats or fish
  2. Aged cheese (cheddar, blue cheese, Camembert)
  3. Fermented cabbage (sauerkraut, kimchi)
  4. Soy products (tofu, soy sauce)
  5. Red wine and beer
  6. Iron supplements (separate them from your medication dose by two hours or more)

In addition, fruits and vegetables in your diet may protect nerve cell function and possibly help keep Parkinson’s symptoms under control. Fruits and veggies also provide fiber, which can stimulate bowel movement and prevent constipation. Ask your doctor for a referral to a nutritionist to help make it easier to follow a healthy diet.

Gait Training to Improve Balance

Patients with Parkinson’s symptoms can enhance their treatment by doing what’s called “gait training” at home. This involves practicing new ways to stand, walk, and turn. People undergoing gait training should try to:

  1. Take large steps when walking straight ahead, focusing on proper heel-toe form.
  2. Keep the legs at least 10 inches apart while turning or walking in order to provide more support and reduce the risk of falls.
  3. Avoid shoes with rubber soles, as they can stick to the floor and increase risk of falls.
  4. Walk to a steady rhythm.

Practice gait training with the help of a metronome, a tool musicians use to keep a steady beat. A study published in March 2010 in PLoS One showed that when people with Parkinson’s walked to the sound of a metronome set about 10 percent faster than their fastest stride, it significantly improved their gait.

RELATED: 10 Things Your Doctor Won’t Tell You About Parkinson’s Disease

You can also try dance classes for people with Parkinson’s through the Dance for PD program, which is supported by a grant from the National Parkinson Foundation. The classes first started in Brooklyn, New York, and are now found in locations across the globe.

Staying Safe at Home With Parkinson’s

Simple changes around the home can make it easier for you to function well while dealing with Parkinson’s symptoms. Pituch notes that healthcare providers can help you come up with a detailed plan for living safely and independently at home.

Discuss specific strategies with your Parkinson’s medical team to design a safer living space. Occupational therapists can suggest ways to create an environment that’s friendly to those with Parkinson’s; this type of therapist looks at things like furniture placement, handrails, extensions on toilets, and floor coverings to determine where possible hazards lie.

Herbal Medicine Formulas for Parkinson’s Disease: A Systematic Review and Meta-Analysis of Randomized Double-Blind Placebo-Controlled Clinical Trials

Introduction

Parkinson’s disease (PD) is a common chronic neurodegenerative disease characterized by the degeneration of dopaminergic neurons in the substantia nigra (SN) (Kalia and Lang, 2015), and presents with non-motor or/and motor syndrome (Rogers et al., 2017). In the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, PD was the second leading cause in neurological disorders of years lived with disability (YLDs), contributing to 6.1 million of patients (GBD, 2016 Disease and Injury Incidence and Prevalence Collaborators, 2017). From 2005 to 2015, global deaths due to PD increased by 42.4%, to 117.4 thousands deaths (GBD, 2015 Mortality and Causes of Death Collaborators, 2016), as a result of population aging. With the growing incidence, PD seriously hurt the physical and mental health of the elderly, also produced a heavy economic burden on both families and society. The average annual cost per PD patient was $22,800 in the United States (Kowal et al., 2013) and $36,085 in the UK (Findley et al., 2011). Current conventional treatment for PD is based on the dopamine (DA) replacement therapies and reduction of DA degradation, including levodopa, DA receptor agonists, monoamine oxidase-B inhibitors, catechol-O-methyltransferase inhibitors and other types of drugs (Rogers et al., 2017). However, all the current therapeutic approaches remain palliative and can’t inhibit or reverse the progression of PD (Athauda and Foltynie, 2015). Furthermore, frequently with these treatments can lead to obvious adverse events and efficacies diminished, as well as induce therapy-related motor complications such as dyskinesia, choreoathetosis, and fluctuations in motor function (Jenner, 2015). A safer and more effective alternative treatment of PD is increasingly demanded.

The therapy of herbal medicine (HM) for PD is particularly common. In China, HM could be traced in the Huangdi Neijing (Inner Canon of Yellow Emperor) (Zheng, 2009), the earliest existing classics in Chinese herbal medicine (CHM). Up to now, HM is still very popular in the treatment of PD especially in Asian countries (Wang et al., 2011, 2013). Previous reviews (Wang et al., 2012; Zhang et al., 2015) found lack of evidence of supporting the use of HM for PD patients because of the generally low-quality studies included. Here, we performed a systematic review and meta-analysis of randomized double-blind placebo-controlled clinical trials of HM formulas for PD patients and further explored the mechanisms of high-frequently used herbs against PD.

Methods

This systematic review and meta-analysis is conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (Moher et al., 2010b) and our previous study (Yang et al., 2017).

Search Strategy

Randomized double-blind placebo-controlled clinical trials of HM formulas for PD were searched in eight databases from their inception to February 2018. They are PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of science, Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang database and Chinese Biological Medical Literature Database (CBM). Moreover, we hand searched additional relevant studies using the reference list of previous reviews. The search strategy of PubMed was as follows, and was modified to suit other English or Chinese databases.

PubMed search strategy:

#1. Parkinson disease

#2. Parkinson*

#3. #1OR #2

#4. Medicine, Chinese Traditional

#5. Herbal Medicine

#6. Integrative Medicine

#7. traditional Chinese medicine

#8. herb*

#9. #4 OR #5 OR #6 OR #7 OR #8

#10. #3 And #9

Study Selection

Two authors (CS-S and H-FZ) independently engaged in the selection of studies by reading study titles, abstracts and full texts. The disagreement was resolved by the corresponding author (GZ) or repeated discussion.

Inclusion Criteria

Type of study: the articles were randomized double-blind placebo-controlled clinical trials.

Type of participants: participants were of any age or sex with a confirmed diagnosis of PD according to the UK Brain Bank criteria (Hughes et al., 1992), Chinese National Diagnosis Standard (CNDS) for PD in 1984 (Wang, 1985), CNDS updated version in 2006 for PD (Zhang, 2006) or other formal comparable criteria.

Type of intervention: Analyzed interventions were HM formulas or HM formulas plus western conventional medicine (WCM) according to PD treatment guidelines, 2 regardless of the form of the drug, dosage, frequency or duration of the treatment. Comparator interventions were placebo or placebo plus WCM.

Exclusion Criteria

Studies were excluded if they were any one of the followings: (1) clinical trials evaluating the other alternative and complementary medicines mixed in the experimental group or control group in the treatment of PD; (2) single herb, herbal extracts and herbal components; (3) case series, reviews, comments and protocols; (4) animal studies and in vitro studies; (5) duplicated publications.

Quality Assessment

The methodological quality was evaluated by using the Cochrane Collaboration’s risk of bias tool (Higgins et al., 2011). The quality of each study was assessed by following seven biases: adequate sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, incomplete outcome data addressed (ITT analysis), free of selective reporting and other bias. Each domain can be rated as “+” (low risk of bias), “-” (high risk of bias), or “?” (unclear risk of bias), which were the three categories for the degree of each potential bias.

Data Extraction

Two authors (CS-S and HF-Z) independently extracted the data according to predefined extraction form as follows: (1) General information: the first author’s name, publication year, and publication language; (2) Participants: diagnostic criteria, study design, total number and number in comparison groups, gender and mean age; (3) Intervention: herbal preparations, dose, frequency, course of treatment, follow-up; (4) Outcome measures. If the study had multiple comparison groups, we chosen the most relevant groups for analysis. The original authors were contacted if further information was needed. Disagreements were resolved through discussing with corresponding author (GZ).

The constituent of HM formulas for PD in each included study was recorded. The herbs with cumulative frequencies over 50% are documented and ranked.

Data Synthesis and Statistical Analysis

We synthesized all data and performed meta-analyses on RevMan 5.3 software. Continuous outcomes were using weighted mean differences (WMD) or standardized mean differences (SMD) with 95% confidence intervals (CIs), while dichotomous outcomes were summarized using risk ratio (RR) with 95% confidence intervals (CIs). Heterogeneity among studies was detected by I2 and Chi2 tests. If substantial statistical heterogeneity existed (I2 ≥ 50%, P < 0.10), a random-effects model was used. If there was no observed heterogeneity (I2 < 50%, P > 0.10), a fixed-effect model was applied. Possible sources of heterogeneity were explored by subsequent sensitivity analyses. If more than ten trials were identified in each outcome, publication bias was detected by funnel plot analyses and Egger’s test.

Results

Description of the Screening Process

The detailed screening process was summarized in the PRISMA flow diagram (Figure 1). A total of 7,521 potentially relevant hits were initially yielded from the eight databases and other sources, in which 6,570 records were remained after removal of duplicates. Through screening titles and abstracts, we excluded 5,824 papers because they were studies with no relevance to PD (n = 3292), nonclinical trials (n = 1007), case reports, reviews, comments OR protocols (n = 1525). After full-text evaluation, 732 papers were excluded, including 234 that were not CHM studies, 142 that contained mixed interventions, 38 that aimed at single herb, herbal extracts or components, 305 that were not randomized double-blind placebo-controlled trials, and 13 that observed no outcome of interest. Ultimately, 14 eligible studies (Pan et al., 2009, 2011, 2013; Zhao et al., 2009, 2013; Guo, 2010; Kum et al., 2011; Chen M. Y. et al., 2014; Guo et al., 2014; Wen et al., 2015; Li et al., 2016; Yu, 2016; Cai et al., 2017; Yang, 2017) were selected in our study.

FIGURE 1

Figure 1. Flow diagram of the search process.

Study Characteristics

TABLE 1

Table 1. Characteristics of the included studies.

Description of the HM Formulas

TABLE 2

Table 2. Ingredients of TCM formula.

TABLE 3

Table 3. The 11 high-frequency used herbs for PD in the 14 trials included.

Assessing the Quality of Studies

FIGURE 2

Figure 2. Risk of bias of the included studies. (A) Risk of bias summary: judgements about each risk of bias item for each included study. (B) Risk of bias graph: judgements about each risk of bias item presented as percentages across all included studies. +, low risk of bias; -, high risk of bias; ?, unclear risk of bias.

Effect Estimation

HM Monotherapy vs. Placebo

HM Plus WCM vs. Placebo Plus WCM

FIGURE 3 FIGURE 4

Adverse Events

In the only one study (Zhao et al., 2009), neither the experimental group nor the control group provide any information about adverse events.

FIGURE 5

Figure 5. Forest plot of HM plus WCM vs. placebo plus WCM in terms of adverse events.

Publication Bias

We did not performed the Funnel plot and Egger’s test because the number of studies in each meta-analysis was less than ten.

Discussion

Summary of Evidence

This is first systematic review of randomized double-blind placebo-controlled clinical trials to assess the efficacy and safety of HM formulas for PD. Fourteen high-quality randomized controlled trials (Pan et al., 2009, 2011, 2013; Zhao et al., 2009, 2013; Guo, 2010; Kum et al., 2011; Chen M. Y. et al., 2014; Guo et al., 2014; Wen et al., 2015; Li et al., 2016; Yu, 2016; Cai et al., 2017; Yang, 2017) involving 1,316 patients suffering from PD were identified. HM paratherapy was significant for improving motor symptoms and non-motor functions, whereas there was a negative result of complications of treatment. One trail (Zhao et al., 2009) indicated that HM monotherapy was not superior to the placebo. Eleven out of fourteen studies (Guo, 2010; Kum et al., 2011; Pan et al., 2011, 2013; Zhao et al., 2013; Chen M. Y. et al., 2014; Guo et al., 2014; Li et al., 2016; Yu, 2016; Cai et al., 2017; Yang, 2017) reported no serious adverse events relevant with HM formulas, indicating that HM formulas were generally safe and well tolerated for PD patients. Thus, the findings of present study supported the complementary use of HM paratherapy for PD patients, whereas HM monotherapy for PD is still lack of evidence.

Limitations

First, the members of the International Committee of Medical Journal Editors published a statement requiring that all clinical trials must be registered in order to be considered for publication (DeAngelis et al., 2004). However, most of included studies didn’t formally register. Protocols were not available to confirm free of selective reporting. Thus, further clinical trials must register prospectively in international clinical trials registry platform. Second, although we included randomized double-blind placebo-controlled trials, some inherent and methodological weaknesses still existed in the primary studies: (1) An adequate sample size is crucial to the design of RCTs (Lewis, 1999), but only 4 trials (Kum et al., 2011; Zhao et al., 2013; Li et al., 2016; Yu, 2016) applied pre-trial sample size estimation; (2) PD is a chronic degenerative disease. Long-term efficacy and safety are important assessments to decide the clinical usefulness of an agent in treatment, but only one trial (Li et al., 2016) had the long-term duration of follow-up at 6 month; (3) Intention-to-treat (ITT) analysis could avoid bias and false-positive results, which is the recommended standard approach to analyse data from RCTs (Abraha et al., 2017). However, only two studies (Kum et al., 2011; Li et al., 2016) adopted ITT analysis. (4) In the present study, only 6 trials conducted assessor blinding. Considering the characteristics of outcome measurement of PD patients (e.g., UPDRS), assessor blinding successfully eliminates assessment bias and increases the accuracy and objectivity of outcomes results. Triple blindness is needed in further PD trials. Thus, CONSORT 2010 statement (Moher et al., 2010a) and CONSORT Extension for Chinese Herbal Medicine Formulas 2017 (Cheng et al., 2017) should be applied in trial reporting and publication. Third, the herbal composition, drug formulation and dose of the intervention were not exact same, which would lead to clinical heterogeneity. To assess the efficacy and safety of HMs in a clinical trial, all subjects should be given exactly the same intervention in terms of product identity, purity, dosage, and formulation. Fourth, our study only included trials published in the English and Chinese languages and all the included studies were conducted in China, which may affect the generalizability of present findings. In the further studies, the international coliaboration is needed in order to get more qualified stuidies. Finally, different types and stages of PD can influence disease progression and response to treatment (Reinoso et al., 2015). It is difficult to differentiate the effectiveness of HM formulas targeting these subgroups due to insufficient data of primary studies. The pertinent research should be conducted in future clinical trials, which would contribute significantly to explore the responsiveness of specific PD subgroup to interventions.

Implications

Up to now, several systematic reviews of traditional medicine for PD (Kim et al., 2012; Wang et al., 2012; Zhang et al., 2014, 2015) have been performed. However, low-quality of included primary studies hindered our conclusions. For example, the two articles written by Kim et al. (2012) and Zhang et al. (2015) belong to high-quality systematic reviews; however, the inherent limitations existed in the included low-quality primary studies. The present study only included randomized double-blind placebo-controlled trials, which remains the gold standard of trial design (Athauda and Foltynie, 2016). These trials reported the detailed randomized methods; placebo-controlled group accounts for the placebo effects that don’t depend on the treatment itself (Chen et al., 2017), and thus increasing the reliability of experiment results. The present study provided the evidence to support HM paratherapy for PD, whereas there is still lack of available evidence for HM monotherapy for PD. However, it should be remembered that a lack of scientific evidence does not necessarily mean that the treatment is ineffective (Kotsirilos, 2005). To explore the efficacy of HM monotherapy for PD is needed in the future.

Currently, most available PD therapies are mainly aimed at motor symptoms (Fox et al., 2018). Non-motor symptoms (NMS) are common in PD patients across all disease stages and are a key determinant of QOL (Martinez-Martin et al., 2012). However, NMS have received limited attention and targeted treatments remain a challenge (Kulisevsky et al., 2018). The present systematic review provided the sportive evidence for the effectiveness and safety of HM paratherapy for NMS of PD patients. Thus, it is worthy of further studies.

Although the exact pathogenic mechanisms underlying selective dopaminergic neurons loss in PD remain unknown, it is believed that oxidative stress and mitochondrial dysfunction, protein misfolding and aggregation, inflammation, and apoptotic cell death play central roles in PD pathogenesis (Sarkar et al., 2016). Obviously, PD is not a result of dysfunction of one specific pathway but rather a combination of interconnected events (Lim and Zhang, 2013). The urgent need in PD is the development of neuroprotective therapy targeting more potential signal pathways (Kalia et al., 2015). However, clinical neuroprotective effects of current agents in PD remain unproven (Löhle and Reichmann, 2010). The most frequently used herbs of HM formulas were selected in the present study, including Radix Salviae Miltiorrhizae, Radix Paeoniae Alba, Ramulus Uncariae Cum Uncis, Radix Rehmanniae, Herba Cistanches, Radix Polygoni Multiflori, Rhizoma Ligustici Chuanxiong, Fructus Corni, Radix Angelicae Sinensis, Rhizoma Acori Tatarinowii, and Radix Astragali seu Hedysari. Based on the high-frequency used herbs, the anti-PD mechanisms of the main active ingredients of herbs in vivo or in vitro trails are as follows: (1) Antioxidant: Danshensu (from Radix Salviae Miltiorrhizae), catalpol (from Radix Rehmanniae), 2,3,5,4′-Tetrahydroxystilbene-2-O-β-D-Glucoside (TSG) (from Radix Polygoni Multiflori), morroniside (from Fructus Corni) and astragaloside IV (AS-IV) (from Radix Astragali seu Hedysari) were shown to alleviate oxidative stress through reducing reactive oxygen species (ROS) level (Bi et al., 2008a; Sun et al., 2011; Chong et al., 2013; Liu et al., 2017; Zhang et al., 2017). Catalpol, and tetramethylpyrazine (TMP) (from Rhizoma Ligustici Chuanxiong) prevented the decrease in the activities of superoxide dismutase, catalase and glutathione peroxidase, and inhibited malondialdehyde overproduction (Bi et al., 2008a; Lu et al., 2014; Li et al., 2016). The Regulation of I3K/Akt/Nrf2 signaling pathway by Danshensu (Chong et al., 2013) and the inhibition of Nrf2/HO-1 pathway by TMP (Michel et al., 2017) contributed to their antioxidant role; (2) Anti-inflammatory: Echinacoside (ECH) (from Herba Cistanches) and catalpol showed a stronger inhibition on the productions and/or expressions of several pro-inflammatory cytokine, including nitric oxide (Tian et al., 2006), tumor necrosis factor-α (Tian et al., 2006), interleukin (IL)-1α (Tian et al., 2006), IL-1β and IL-6 (Wang et al., 2015). TMP (Michel et al., 2017) may inhibit the expression of neuroinflammation markers: nuclear factor κB (NF-κB), inducible nitric oxide synthase, cyclooxygenase-2, and glial fibrillary acidic protein; (3) Anti-apoptotic: ECH, TSG, morroniside, paeoniflorin (PF) (from Radix Paeoniae Alba), TMP, n-Butylidenephthalide (BP) (from Radix Angelicae Sinensis), or AS-IV exerted anti-apoptotic capacity in different aspects, including suppressing the upregulation of the ratio of Bax/Bcl-2 (Sun et al., 2012; Lu et al., 2014; Liu et al., 2017; Michel et al., 2017), the activation of caspase-3 and caspase-8 (Geng et al., 2007; Sun et al., 2011; Lu et al., 2014; Michel et al., 2017) and the expression of Proapoptotic Gene egl-1 (Fu et al., 2014). TSG (Qin et al., 2011) reduced MPP+-induced apoptotic that mediated via PI3K/Akt signaling pathway; (4) The Regulation of mitochondrial dysfunction: ECH, TSG, PF or catalpol attenuated mitochondrial dysfunction not only by suppressing the decrease of cellular ATP levels (Wang et al., 2015), mitochondrial membrane potential (Bi et al., 2008b; Sun et al., 2011, 2012; Wang et al., 2015), the activity of mitochondrial complex I (Bi et al., 2008b), but also decreasing mitochondrial permeability transition pore opening (Bi et al., 2008b); (5) DA and dopaminergic neuron protection: Danshensu, ECH, BP, TMP, AS- IV or β-asarone (from Rhizoma Acori Tatarinowii) could enhance the content of DA as well as its metabolites and reduce dopaminergic neuron degeneration (Geng et al., 2007; Chong et al., 2013; Fu et al., 2014; Lu et al., 2014), and led to a marked increase in Tyrosine hydroxylase expression (Geng et al., 2007; Lu et al., 2014; Zhang et al., 2016; Liu et al., 2017). Furthermore, catalpol (Bi et al., 2008b) was found to be a strong inhibitor of MAO-B, which may weaken the biotransformation of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine to 1-methyl-4-phenylpyridinium and the metabolism of DA; (6) Reduce α-synuclein accumulation: α-synuclein (α-syn) is a major component of lewy bodies that plays an important role in the pathogenesis of PD (Rocha et al., 2018). Corynoxine (Chen L. L. et al., 2014) (from Ramulus Uncariae Cum Uncis) down regulated α-syn in PC12 cells by inducing autophagy. AS-IV (Liu et al., 2017) inhibited the expression of the α-syn via the p38 MAPK signaling pathway. Furthermore, β-asarone (Zhang et al., 2016) promoted the clearance of α-syn via regulating long non-coding RNA Metastasis associated lung adenocarcinoma transcript 1. Because of their advantage of multi-component, multi-target and multi-pathway, HM formulas have great potential application value in neuroprotection. Furthermore, based on the high-frequency used herbs, we can explore the best formula combination, which also ignite the HM treatment method for PD patients.

Conclusion

The findings of present study showed that HM paratherapy can effectively improve the motor symptoms and non motor symptoms of PD and is well tolerated for PD patients. Thus, the available evidence supported the complementary use of HM paratherapy for PD patients; however, the question on the efficacy of HM monotherapy in alleviating PD symptoms is still open.

Author Contributions

Funding

This work was financially supported by the grant of National Natural Science Foundation of China (81573750/81473491/81173395/H2902); the Young and Middle-Aged University Discipline Leaders of Zhejiang Province, China (2013277); Zhejiang Provincial Program for the Cultivation of High-level Health talents (2015).

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Parkinson’s Disease

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What is Parkinson’s disease?
Parkinson’s disease is the second most common neurodegenerative disorder worldwide after Alzheimer’s disease. Parkinson’s affects nerve cells in the part of the mid-brain known as the substantia nigra, responsible for muscle movement. The result is tremors, rigidity, slow movements and difficulties with balance . Its signs and symptoms worsen over time, eventually leading to cognitive problems including dementia. But although Parkinson’s may result in disability, the disease often moves slowly, and most people have a number of years of only minor disability following a diagnosis.

The motor symptoms alone are known as parkinsonism – they may be due to Parkinson’s disease, or to a number of other causes that may be temporary or reversible.

The disease is named after James Parkinson, a British physician who published the first detailed description of the condition in 1817. Famous Americans including actor Michael J. Fox and boxer Muhammed Ali have the condition, and have raised awareness of it via books, appearances and interviews on behalf of groups such as the National Parkinson Foundation.

What are the causes?
There appears to be a genetic component, as people with a first-degree relative who has Parkinson’s, such as a parent, child or sibling, are at greater risk. In March of 2011, researchers at Mount Sinai School of Medicine published research indicating that mutations in a gene called LRRK2 are associated with the most common inherited form of the condition.

In addition, and even in people who are genetically predisposed to Parkinson’s disease, many experts believe that environmental exposures, such as unusual exposure to herbicides and pesticides, increase a person’s risk of developing Parkinson’s disease.

Certain drugs, when taken for long periods of time or in amounts greater than recommended, can cause parkinsonism. These include medications such as Haldol (Haloperidol) and Thorazine (Chlorpromazine), used to treat psychiatric disorders, as well as drugs used to treat nausea, such as Reglan (Metoclopramide ). The anti-seizure drug, Depakene (Valproic Acid), also may cause some of the features of parkinsonism, notably severe tremor. These medications do not result in Parkinson’s disease, however, and symptoms resolve when the medications are no longer used.

Who is likely to get it?
Parkinson’s disease generally begins in middle or late life, and the risk continues to increase as people age. Other risk factors include:

  • Heredity
  • Gender – men are at greater risk than are women
  • Reduced estrogen levels

What are the symptoms?
Initial symptoms may include: an arm that refuses to swing when you walk, a mild tremor in the fingers of one hand or slurred speech. You may lack energy, feel sad or have difficulty sleeping. Daily activities may take longer than normal. Other signs and symptoms can include:

  • Tremor involving other parts of the body
  • Slowed motion
  • Stiff muscles
  • Impaired balance
  • Loss of automatic movements
  • Additional speech problems
  • Trouble swallowing
  • Dementia

How is it diagnosed?
A diagnosis of Parkinson’s disease is made based on medical history and a thorough neurological evaluation – there are no specific blood test or x-ray results that can definitively support the diagnosis . Your physician will inquire about any medications you take and whether you have a family member with Parkinson’s. The doctor will assess your balance, walking, coordination and dexterity. Even if the symptoms are not apparent to you, a trained physician may detect subtle signs of parkinsonism – reduced facial expressions, a lack of gestures or a slight tremor.

What is the conventional medical treatment?
Conventional treatment often includes medication. The most commonly used drug is levodopa, also known as L-DOPA, which is converted to dopamine in the brain. Because motor symptoms are the result of a relative lack of dopamine, administration of levodopa can temporarily reduce motor symptoms.

Other classes of drugs used to counter Parkinson’s symptoms include:

  • Dopamine agonists
  • MAO-B inhibitors
  • Cholinesterase inhibitors
  • Anticholinergenics
  • Amantadine

Treating motor symptoms with surgery was once common, but the advent of levodopa led to a reduction in surgeries. Today, for people with advanced cases for whom drug therapies no longer work well, surgery is again becoming a viable treatment option as surgical procedures become more targeted and sophisticated. The most common type of surgical intervention is deep brain stimulation (DBS). This involves implanting a device known as a brain pacemaker that sends electrical signals to specific parts of the brain to calm motor fluctuations and tremor.

What therapies does Dr. Weil recommend?
The tremor associated with Parkinson’s typically occurs when your hands are at rest. You can take the following steps to relieve or reduce shaky hands: Avoid caffeine, which can trigger production of adrenaline, a hormone that can worsen tremors. Avoid alcohol, which has pronounced effects on the central nervous system and can aggravate essential tremor, a condition that is sometimes confused with Parkinson’s disease. Regular exercise, including the use of light hand weights to promote stability in the hands and wrists, and consideration of tai chi to gently enhance balance, can be very beneficial. Ask your physician to recommend a physical therapist who can create an individualized fitness program for you .

Preliminary but promising evidence indicates that high-doses of coenzyme Q10, also known as CoQ10 – at a level of 1,200 mg a day – may be beneficial. Take CoQ10 with a meal containing fat for best absorption. The best form to use is a softgel capsule.

Parkinson’s disease can also be a predisposing factor in frozen shoulder (the medical term is adhesive capsulitis), a painful condition that can also limit arm movement on the affected side of the body. Dr. Weil suggests acupuncture and osteopathic manipulation; both can be helpful, and both are safer than more invasive measures. He also recommends trying DMSO (dimethyl sulfoxide) topically. You can buy it at your health food store or on the internet. It penetrates the skin and promotes healing of pockets of inflammation. Make a 70 percent solution of DMSO by diluting a 100 percent solution with distilled water and apply it to the shoulder with absorbent cotton. Let it dry. Apply the solution three times a day for three days. If you do not see any improvement, stop using it. If you do notice improvement, cut back to twice a day for three more days, then once a day for a final three days. After that your body can continue healing on its own.

One of the issues that people with Parkinson’s disease sometimes find themselves dealing with is an overactive bladder, or urge incontinence. Dr. Weil recommends trying these approaches for urge incontinence before resorting to drugs:

  • Watch your weight – excess pounds can stress the bladder and increase the risk of incontinence.
  • Do not smoke. Incontinence is twice as common among smokers as it is among nonsmokers.
  • Avoid bladder irritants such as caffeine, alcohol, and spicy foods. Avoid feminine deodorants, which can irritate the urethra.
  • Practice Kegel exercises to strengthen pelvic-floor muscles and improve bladder control.
  • Consider biofeedback, which can help you identify and strengthen your pelvic floor muscles and can help with Kegel exercises.
  • Discuss bladder retraining programs with your physicians. These can help you control the urge to “go” by scheduling bathroom trips and gradually lengthening the time between them.
  • In addition, try keeping a bladder diary, which may help reveal what triggers your urge symptoms.

Many people with chronic illness experience depression as a result of their health circumstances, but Parkinson’s disease can also precipitate biochemical changes in the brain that may result in depression. Mild forms of depression may not require medication. In Buddhist philosophy, depression represents the inevitable consequence of seeking stimulation. The centuries-old teachings suggest that we seek balance in our emotional lives, rather than continuously striving for the highs, and then complaining about the lows that follow. Its basic recommendation encourages the daily practice of meditation, and this is perhaps the best way to address the root of depression and change it. This approach to managing mild depression requires long-term commitment, however, as meditation does not produce immediate results. For more immediate, symptomatic treatment of depression, there is no better method than regular aerobic exercise. Numerous studies have demonstrated the efficacy of a daily workout for improving mood and boosting self-confidence. Dr. Weil recommends thirty minutes of continuous activity, at least five days a week for best results. For those with more advanced forms of depression, specific therapy may be advised by your doctor.

How is it prevented?
Avoid exposure to environmental toxins such as pesticides, as heavy pesticide exposure (such as that experienced by agricultural workers) is one of the most clearly established risk factors for the development of the disease. Beyond this precautionary principle, however, preventive strategies against Parkinson’s disease are general in nature.

The anti-inflammatory diet counteracts the chronic inflammation that is a root cause of many serious diseases that become more frequent after age 60. Normally, inflammation occurs in response to injury and attack by germs. It is marked by local heat, redness, swelling, and pain, and is the body’s way of getting more nourishment and more immune activity to an area that needs them.

But inflammation is not always helpful. It also has destructive potential. We see this when the immune system mistakenly attacks normal tissues in such autoimmune diseases as type 1 diabetes, rheumatoid arthritis, and lupus. And we now know that inflammation also plays a causative role in heart disease, Alzheimer’s and Parkinson’s diseases, as well as other age-related disorders, including cancer.

The anti-inflammatory diet emphasizes a variety of colorful vegetables and fruit, slow-digesting carbohydrates, plant-based protein, and healthy fats.

Complementary and Alternative Therapies

People with chronic diseases like Parkinson’s disease (PD) frequently turn to complementary and alternative medicine (CAM) to help them manage their symptoms and improve their quality of life. However, medical professionals emphasize that PD should not be treated with alternative medicine alone. Used with traditional medicine, CAM may help relieve symptoms of PD. Some CAM approaches have the potential to interfere with some medications used to treat PD or could cause severe side effects, and people with PD should talk to their doctor about all therapies and practices they are using to manage their symptoms.1

The difference between alternative and complementary medicine

While the terms “complementary medicine” and “alternative medicine” are sometimes used interchangeably, they actually refer to different concepts. Alternative medicine is a term that means any medicinal products or practices that are not part of mainstream medicine given by medical doctors and allied health professionals, such as nurses or physical therapists. Alternative medicine has not necessarily been tested in clinical trials, and it is also defined by its use as an alternate to traditional medical care. Complementary medicine is used in combination with traditional medicine. There have been research studies on many alternative and complementary medicine practices to determine their effectiveness in treating a range of conditions, including Parkinson’s disease. The U.S. Food and Drug Administration (FDA) does not review alternative and complementary medicine therapies.2

Types of complementary and alternative medicine

People with PD use a variety of CAM approaches as they seek to relieve their symptoms from their disease, such as:

  • Massage – Massage is a general term that describes using touch to press, rub, or manipulate the skin, muscles, tendons, and ligaments. Massage is often used to reduce stress and pain and relieve muscle tension.3,4
  • Acupuncture – Acupuncture is the use of thin needles inserted through the skin at strategic points on the body. It is a key component of traditional Chinese medicine and is most often used to treat pain.3
  • Dietary supplements, natural remedies or herbs – Dietary supplements are products that contain a dietary ingredient, such as a vitamin, mineral, amino acid, or herb. Herbal remedies refer to the use of plant and plant extracts. These products are taken by mouth and are intended to add nutritional value, help manage symptoms from PD, or improve general health and well being. Because of potential side effects or interactions with PD medications, all dietary supplements, natural remedies, or herbs should be discussed with a doctor.5,6
  • Yoga – Yoga is a mind and body practice that originated in ancient India. There are several practices in yoga, usually combining physical poses, breathing techniques, meditation, and relaxation. Yoga may help people with PD to increase flexibility and balance.3
  • Tai chi – Tai chi is a form of exercise that comes from ancient China. It uses slow, flowing motions that may help people with PD improve balance, flexibility and muscle strength.3
  • Meditation – Meditation involves quieting the mind and may use images or words to focus on. Meditation may help reduce stress and improve a person’s sense of well being.3
  • Music or art therapy – Some people with PD use the arts, such as music, painting, or ceramics, to help them relax. Music therapy can also be helpful for walking or speech challenges experienced by people with PD.3
  • Medical marijuana or CBD oil – Although medical marijuana, known also as medical cannabis, has had mixed clinical results, many people with PD find that it helps to alleviate certain PD symptoms, such as pain. In one study, relief was reported in pain reduction, improved sleep, and some psychological components. 6,7

Over the Counter & Complementary Therapies

Our understanding of Parkinson’s disease (PD) has evolved from the initial focus on motor symptoms to now include non-motor symptoms (such as, mood, fatigue, constipation) of the disease. People with PD who seek relief from their symptoms may decide to explore complementary therapies, which can support or complement traditional medicine. While there are many kinds of complementary medicine, this section focuses on herbs, vitamins and supplements.

Although there is little conclusive scientific information on natural supplements, researchers are examining several substances to evaluate their effectiveness on slowing PD progression and managing its symptoms.

Nutritional supplements are not regulated with the same approval method for prescription drugs. People with PD should discuss any medications (prescription or over-the-counter) with a doctor before taking them to avoid potentially dangerous interactions. If you are considering complementary medicine, we strongly urge you to investigate the credentials and experience of anyone offering advice or recommendations regarding such product.

Key Points

  • Most herbs and supplements have not been rigorously studied as safe and effective treatments for PD.
  • The U.S. Food and Drug Administration (FDA) does not strictly regulate herbs and supplements.
  • There is no guarantee of safety, strength or purity of supplements not monitored by the FDA.

Antioxidants: Vitamin C and E, Mediterranean Diet

Since there is evidence relating oxidative damage of nerve cells to PD, some researchers are studying antioxidants:

  • A 2002 study focused on the potential antioxidant Coenzyme Q10 (CoQ10), which is believed to play an important role in mitochondria health. Mitochondria are the “powerhouses” of a cell. Some scientists think that abnormalities of mitochondrial function may play a role in PD.

In 2011, a large clinical trial studying the potential benefits of CoQ10 on reducing the progression of early PD was stopped because a mid-study analysis suggested that there was no improvement in the people taking CoQ10 in comparison to those receiving treatment. Researchers decided that continuing the study would have shown an extremely low likelihood of CoQ10 showing any benefit in delaying the progression of early PD.

Scientists have also examined Vitamin E, Vitamin C and health foods to evaluate oxidative properties. Vitamin E can fight damage in the brain caused by free radicals and has been suggested to lower the risk of PD. However, researchers conducted an extensive and thorough study more than 10 years ago (the DATATOP trial) and failed to find any evidence that Vitamin E slows the progression of PD or manages symptoms. Since Vitamin E has few side effects, many people with PD continue to take it in high doses of 400 IU or more.

Researchers are also examining if health foods, such as fermented papaya and blueberries, play a role in slowing nerve cell death. Scientists are optimistic about the research, but do not have conclusive data to recommend these supplements to treat PD.

  • Creatine is another supplement of scientific interest. It increases levels of phosphocreatine (an energy source in muscle and brain). The National Institute of Neurological Disorders and Stroke (NINDS) conducted a multi-center clinical trial to study creatine for treatment of early stage Parkinson’s. The study was terminated early due to an interim analysis that did not reveal a significant different between creatine and a placebo.

Researchers have also studied a compound called glutathione to determine its effect on nerve cell metabolism and its power as an antioxidant. Both compounds show promise, but appropriate dosing is unclear, as are the most effective administration method, side effects and long-term dosing risks.

Vitamins C and E

Free radicals are toxic molecules produced by virtually every cell in the body, usually in response to stress or injury. For example, sunlight exposure, cigarette smoking and infection can generate free radical formation in some cell types. These particles are thought to be particularly toxic to brain cells. Antioxidants “soak up” free radicals. Vitamins C and E are antioxidants that fight free radicals and may protect brain cells.

  • Some concerns have been raised about possible side effects of Vitamin E supplements, particularly the form of Vitamin E commonly available (alpha-tocopherol). A “mixed” supplement, containing multiple forms of Vitamin E may be safer or more effective.
  • Good dietary sources include whole grains, wheat germ, avocados, nuts and vegetable oils.
  • Since there is evidence that free radical damage is involved to some extent in PD, Vitamin E, was studied in people with early PD in a large study in the 1980s. The study did not show an effect on disease progression or neuroprotection. Instead it showed that it could potentially be harmful to people with PD and that it is possible that dietary Vitamin E is used more easily by the body than the supplements in the study, however more research is required.

The Mediterranean Diet

  • There is some evidence that the Mediterranean diet, a diet high in monounsaturated fats, such as olive oil, may be beneficial in reducing blood pressure and cardiovascular disease.
  • The diet also emphasizes fish, especially those high in Omega-3 fatty acids, such as salmon and foods containing antioxidants.
  • People with PD are often concerned about the possibility that protein intake can decrease the effectiveness of carbidopa/levodopa, the common medication used to treat PD. Levodopa absorption in the brain can be slowed by a high protein meal. As the disease progresses, most people find their symptoms are better controlled if they consume their protein later in the day.
  • Since PD can affect digestion, many people will notice symptoms such as constipation and early satiety (the sensation of feeling full after consuming a small amount of food).

Calcium

Getting enough calcium can be difficult for people with PD as many find dairy foods more likely than other protein foods to inhibit levodopa absorption. Here are some recommendations that will help you meet your calcium requirements:

  • Drink calcium-fortified orange juice
  • Add calcium-fortified-rice and soy milk alternatives to cereal, smoothies and cooked dishes
  • Switch to breakfast cereals and other foods fortified with calcium
  • Consider taking a calcium supplement — calcium citrate is often a better choice.
  • Chewable calcium tablets are better absorbed since they are already broken down when they reach the stomach.

Vitamin D

  • The current recommendation for vitamin D is 600 IUs for people age 50 or older, and 800 IUs daily for those over the age of 70.
  • The body cannot absorb calcium without adequate amounts of vitamin D.
  • If you live in a sunny area, vitamin D is easy to absorb. Spend about one hour per week outdoors in the sunshine, but wear sunscreen.
  • Because vitamin D is stored, our bodies can conserve enough in the summer to last through winter.
  • If you do not live in a sunny area or prefer to stay indoors, here’s how you can eat to get the amount you need:
    • Fortified foods such as milk and milk substitutes, milk products, margarine and cereals
    • Fatty fish, such as salmon and fish liver oils
    • Liver
    • Eggs

Coenzyme Q-10

Cells need energy to survive and function. They contain mitochondria, which are “batteries” that produce energy. In PD, there seems to be a disturbance in the function of these batteries. Coenzyme Q10 seems to affect this energy-generating mechanism in cells. The exact mechanism remains a mystery.

A trial sponsored by NIH and the Parkinson Study Group was terminated in May 2011 because it showed no neuroprotective or symptomatic benefit of Coenzyme Q10 for people with early PD. However, this negative finding may help scientists focus on possible mechanisms and more promising drugs and studies. Findings of this study are specific to PD. They do not reflect the possible value of coenzyme Q10 in other disorders.

Ginger (Zingiber Officinalis)

Ginger in almost any form is excellent for nausea and vomiting, whether the nausea stems from something as simple as motion sickness or as a side effect of medications. Fresh ginger root, available in the produce section of most grocery stores and markets, can be prepared as a liquid. It can also be taken in other forms:

  • Cover a one-inch slice in water, bring to a boil and simmer for 30 minutes.
  • Ginger is sold in health food stores as a liquid. A drop or two can be added to tea or other beverages.
  • Nibble small pieces of crystallized ginger, available as a cooking spice, at the first sign of queasiness.
  • A Japanese study using a mouse model of PD, found that zingerone, a compound found in ginger root, may have a protective effect on dopamine-containing neurons.

Folate (Folic Acid)

  • Folate (Vitamin B9) is another vitamin that is important for brain health and good memory.
  • Vital for the development of the nervous system and insuring adequate amounts during pregnancy can prevent certain types of birth defects.
  • Folic acid, along with B12 and possibly B6, can decrease levels of homocysteine, which may prevent strokes and heart attacks and help memory as well.

Green Tea Polyphenols

  • Green Tea Polyphenols (GTP) have antioxidant and free radical scavenging activities.
  • Some studies have suggested that these compounds could have a neuroprotective effect and possibly even a treatment effect in PD.
  • The Chinese Ministry of Health and the Michael J. Fox Foundation, with the assistance of Dr. Caroline Tanner of the Parkinson’s Institute and Clinical Center, a Parkinson’s Foundation Center of Excellence in Sunnyvale, CA, conducted a study to evaluate GTPs ability to slow disease progression and its safety and tolerability in Early PD. After one year, there was no significant difference between those who took GTP or a placebo. There was a change noted in the total UPDRS score in the “delayed-start” group from 6 months (began GTP) to 12 months, suggesting there may be a slight benefit. However, additional research is needed particularly to understand the dose effect. Insomnia was slightly increased in the GTP group, suspect this is related to the caffeine content.

Caution: Green tea products contain caffeine. Take this into consideration when using them.

Milk Thistle (Silybum Marianum)

  • Many drugs and environmental toxins are processed through the liver. Milk thistle has been used to treat disorders of the liver and gallbladder for at least 2,000 years.
  • Research shows that the silymarin in milk thistle helps protect the liver from many industrial toxins, such as carbon tetrachloride.
  • There is also evidence that compounds from milk thistle seeds help protect the liver against damage from alcohol and hepatitis and can even regenerate damaged liver cells.
  • Helps improve liver function by helping to remove toxins from the body.
  • In his book, The Brain Wellness Plan, neurologist Dr. Jay Lombard advises people with PD who take anti-Parkinson’s drugs (metabolized through the liver) to add 300 mg of standardized milk thistle extract to their daily medication regime.
  • Available in capsules.
  • The compound appears to be safe, although more testing is needed to determine if there are any negative long-term effects. There are no published studies of milk thistle in the treatment of PD.

St. John’s Wort (Hypericum Perforatum)

  • Herbal supplement is a popular anti-depressant, working in a pharmacologic manner similar to the prescription selective serotonin reuptake inhibitor (SSRIs).
  • May be effective in mild to moderate depression, but two studies reported no benefit in major depression.
  • The most frequently prescribed antidepressant medication in Germany. The most common dose being 300 mg, three times daily.
  • Although Hypericum Perforatum is one substance known to be present in the flowers and leaves of this plant, it also contains other unidentified compounds that appear to be active.
  • In one study of Hypericum Perforatum in a mouse model of PD, there appeared to be some inhibition of the effect of the toxin (MPTP) used to cause Parkinsonism.

Caution:

  • St. John’s Wort may interfere with certain PD medications, most particularly MAO-B inhibitors.
  • St. John’s Wort should not be used concurrently with other antidepressant medications. People taking Prozac, Zoloft, Paxil or other SSRIs risk serious overdose effects by using Hypercom.
  • St. John’s Wort should not replace traditional prescription medicine for the treatment of a serious or major depressive episode.
  • Do not take St. John’s Wort if you take blood thinners such as aspirin, heparin or warfarin (Coumadin).
  • People with PD who also take asthma medications, steroids, birth control pills, cough medicine, digoxin, immunosupressants, HIV medications, triptans (used to treat migraines) should consult their physicians or health care providers before taking St. John’s Wort.
  • Do not drink alcohol while taking St. John’s Wort.

Vitamin B12

  • Important factor in brain and nerve health, especially memory.
  • Dietary Vitamin B12 is found in animal protein sources such as meat, eggs, fish and dairy products.
  • As people age, they may develop difficulty absorbing B12 from the gut, even if the amount in their food sources is adequate.
  • Oral supplements (usually 1000 mcg) may help, although persons with severe B12 absorption problems or deficiencies may require injections.
  • Vegetarians may also develop a B12 deficiency.
  • A chemical called homocysteine can become elevated in people with PD, often in conjunction with levodopa therapy. There is an unproven theory that the elevation of homocysteine may be related to memory loss in some cases. Increasing B12 and folic acid will often result in a decrease in homocysteine levels, though it is not yet known whether this will improve memory.

Over-the-Counter (OTC) Medications

Although nutritional supplements have shown some promising results in preliminary studies, it is important to remember that there is not sufficient scientific data to recommend them for Parkinson’s. OTC medications have side effects and interactions with other drugs. They tend to be expensive and vary with different manufacturers. Before taking any OTC medication, a person with PD must discuss adding these supplements with their doctor.

Summary

It is important for people with Parkinson’s to let their health care providers know of any herbal products, vitamins, over-the-counter medications and dietary changes they have made on a regular basis. Some of these compounds may interact or interfere with PD medications.

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.

Parkinson’s tremor is a common motor symptom seen in patients with the neurodegenerative disorder, Parkinson’s disease.

What is a parkinsonian tremor?

A tremor is an involuntary, uncontrollable muscle contraction, which manifests as shaking in body parts, most commonly the hands. About 70 percent of Parkinson’s disease patients experience tremors in the early stages of the disease. There are two types of tremors: Resting tremors and action tremors.

Resting tremors

Resting tremors are the most common form of tremors associated with Parkinson’s disease. They occur when the muscles are relaxed and still, such as when the patient is lying in a bed or when their hands are resting on their lap.

In Parkinson’s disease, resting tremor often can be referred to as a “pill-rolling tremor,” due to the actions of the tremor resembling the motion of rolling a small pill between the thumb and index finger.

Action tremors

Action tremors are less common in Parkinson’s, but it is still predicted that more than 25 percent of patients experience them. An action tremor occurs alongside a voluntary movement and can be further classified based on the movement they accompany.

Tremors not associated with Parkinson’s disease

There are different types of tremors, of which not all are associated with Parkinson’s disease, and they vary slightly in terms of how, when and where they manifest in the body. They include essential tremor and dystonic tremor and may be associated with other conditions and genetic mutations, although a specific gene has not been identified.

A patient with a Parkinson’s tremor typically will find that their symptoms worsen and spread to other parts of the body over time. Generally, the tremor starts in one hand and can progress (normally over the course of many years) to the arm and foot on the same side of the body, and then eventually to the other side of the body. In severe cases, tremors also can affect the jaw or lips.

What treatments are there for tremors?

Parkinson’s tremors cannot be cured. However, there are several options to manage them.

Many of the typical Parkinson’s drug treatments are associated with a reduction in tremors, including levodopa and dopamine agonists. A surgical procedure called deep brain stimulation (DBS) also may be offered to control unmanageable tremors.

Physical therapy can help some patients control their tremors better, as can reducing the intake of substances such as caffeine, which can induce tremors. Many patients experience an increase in the severity of their tremors when they are stressed. Therefore, trying to reduce sources of anxiety and engaging in complementary therapies (such as yoga or aromatherapy) may help some patients.

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Motor symptoms

There is no cure for tremor, but there are many ways to manage it.

Management of tremor

There is no cure for tremor, but there are many ways to manage it. Good control of tremor requires optimal control of Parkinson’s with medications.

All involuntary movements, including tremor, are worsened by emotional or physical stress, anxiety, fatigue and illness. Many people find that complementary therapies which promote relaxation and reduce stress help them. Exercise may also help to boost energy levels, reduce fatigue and improve wellbeing. Changes to your diet may also be beneficial.

Stimulants such as caffeine, coffee, chocolates and recreational drugs also worsen tremor so it is a good idea to watch how much of these you consume. Alcohol withdrawal can also cause tremor.

Psychological approaches, including cognitive behavioural therapy, relaxation therapies and medication can also be helpful. Talk with your healthcare team so that they can put you in contact with professionals who can help.

Coping strategies

Many people have discovered and developed strategies that help them to reduce or overcome tremor – their own personal coping strategies. Although these won’t work for everyone, watching some of these video clips in Coping Strategies – Tips & Tricks’ may help you discover and develop strategies of your own.

  • Throwing ball to stop tremor – watch our video
  • Flicking the hands – watch our video
  • Bouncing a ball and running – watch our video
  • Bouncing ball to assist with turning – watch our video
  • Holding hands to calm tremor – watch our video
  • Reducing tremor by gripping – watch our video
  • Juggling apples to control tremor – watch our video
  • Twirling a pen to reduce tremor – watch our video.

Medication

For some people dopaminergic medications and the various forms of levodopa will relieve tremor but in others they may not be effective. These differences in responsiveness have yet to be satisfactorily explained. You will need to work with your doctor to establish a medication regime that works best for you.

Some medications can cause or worsen tremor, for example tranquillisers and anti-sickness drugs. Some antidepressants, asthma and epilepsy medications can also make your tremor worse. Always check the patient information leaflet that comes with medications to see if they are thought to cause or worsen tremor.

Deep brain stimulation

Deep brain stimulation (DBS) is used in some people with Parkinson’s to help control their movement (motor) symptoms, including tremor. DBS passes a small current at high frequency through precisely targeted areas of the brain which appears to block motor symptoms.

DBS is not suitable for everyone. This surgery and its potential risks and benefits should always be discussed with an experienced doctor.

See also, Deep brain stimulation (DBS).

Content last reviewed: October 2018

Complementary therapies

Herbal medicine (or ‘herbalism’) uses plants or plant extracts to treat, prevent or cure illness, and promote good health. Like most other complementary therapies, herbal medicine takes a holistic approach – it aims to treat the whole person, not just the symptoms, and to encourage the body to heal itself.

All parts of the plant are used – roots, leaves, stems and seeds – as herbal practitioners believe the whole herb has a wider healing potential than the single active agent used by the pharmaceutical industry in traditional medicine.

Many well-established, conventional medicines come from plants. For example, morphine comes from poppies, aspirin from willow bark, and digoxin (a treatment for an irregular heart beat) from foxgloves.

Herbal remedies are available as drinks, tablets, capsules, ointments and creams, and are on sale in health food shops, pharmacies and even supermarkets. But they must be approached with caution. They have side effects and regulatory procedures differ from country to country so it is not always clear what the remedy contains, in what concentration, or whether it was manufactured properly. As a result, the safety of herbal medicines is often questioned.

Even established remedies that have been shown to be helpful for certain problems, may not be safe for you, for example if you are taking other medicines. In particular, herbal remedies should not be taken of you have angina, high blood pressure or glaucoma. Herbal treatment should therefore only be taken under supervision from a trained herbalist or doctor.

There is limited scientific evidence on the effects of herbal medicine. Some remedies have been clinically tested in the general population and have been found to be beneficial. For example garlic can reduce blood cholesterol levels and potentially lower the risk of heart disease, ginkgo biloba may improve mental performance in Alzheimer’s disease and St John’s Wort can be used to treat mild to moderate depression but St John’s Wort can interfere with Parkinson’s medications so you should always ask your doctor before taking this remedy. However, the evidence for most herbal medicines is conflicting and further studies are needed.

New Treatment May Have the Potential to Slow, Stop, or Reverse Parkinson Disease

Results from a February study of a revolutionary treatment suggest that it may be possible to slow, stop, or even reverse the progression of Parkinson disease, according to findings in the Journal of Parkinson’s Disease.
The 3-part, experimental study investigated whether using a novel delivery system to increase levels of glial cell line-derived neurotrophic factor (GDNF) can regenerate dying dopamine brain cells in patients with Parkinson disease and even reverse their condition. GDNF is a naturally occurring protein that promotes the survival of many types of neurons.
“I believe that this approach could be the first neuro-restorative treatment for people living with Parkinson’s, which is, of course, an extremely exciting prospect,” Steven Gill, MB, MS, FRCS, who designed the infusion device used in the study, said in a statement.
Researchers used robot-assisted neurosurgery to implant a specially designed delivery system, termed Convection Enhanced Delivery (CED), which allowed high flow rate infusion to be administered to patients every 4 weeks. Patients underwent a procedure to have 4 tubes implanted within their brains. GDNF was directly infused to targeted locations via a skull-mounted transcutaneous port located behind the ear. Following implantation, the trial team administered a total of more than 1000 brain infusions throughout the study. Patients demonstrated a high compliance rate of 99.1% and confirmed clinical feasibility and tolerability toward the administration process for repeated brain infusions.
Initially, 6 patients enrolled in a pilot study which evaluated the safety of the treatment approach. After the pilot study, 35 additional individuals participated in a subsequent 9-month double-blind trial. Half of the participants were randomly assigned to receive monthly infusions of GDNF while the other half received placebos.
Positron emission tomography (PET) brain scans from the group who received GDNF showed an improvement of 100% in the targeted area of the brain affected by Parkinson disease, leading researchers to believe that the treatment may have the potential to reawaken or restore damaged brain cells. There was no change in PET brain scans among the group that received placebo. After the trial period, no improvements in symptoms were observed in either group.
“The spatial and relative magnitude of the improvement in the brain scans is beyond anything seen previously in trials of surgically delivered growth-factor treatments for Parkinson’s,” the study’s principal investigator Alan L. Whone, PhD, FRCP, Translational Health Sciences, Bristol Medical School, University of Bristol, said in a statement. “This represents some of the most compelling evidence yet that we may have a means to possibly reawaken and restore the dopamine brain cells that are gradually destroyed in Parkinson’s.”
Following the 9-month treatment period, a third, open-label extension trial was performed to investigate the effects and safety of continued exposure to GDNF for an additional period of 40 weeks. The group of patients who were already receiving GDNF continued to be exposed to the growth factor. The group that was receiving placebo for the first 40 weeks was then given GDNF.
The study’s primary endpoint was the percentage change in the OFF state Unified Parkinson’s Disease Rating Scale (UPDRS) motor score from baseline to the conclusion of the 80-week period between the group that consistently received GDNF and the group that received placebo and then GDNF.
Although symptoms in both groups were found to either moderately or significantly improve after 18 months, once all participants had received GDNF, no significant differences between the groups in the primary or supplementary endpoints were observed throughout the study. However GDNF treatment was attributed to a significant increase in dopamine uptake.
Safety was assessed according to occurrences of adverse events (AEs), presence of anti-GDNF antibodies, and routine laboratory testing . While all patients experienced at least 1 AE between week 40 to week 80, none led to the discontinuance of receiving study medication. Serious AEs were reported for a total of 8 patients but were determined to be unrelated to study medication. GDNF was determined to by safe when administered over an extended time period.
“This trial has shown that we can safely and repeatedly infuse drugs directly into patients’ brains over months or years. This is a significant breakthrough in our ability to treat neurological conditions, such as Parkinson’s, because most drugs that might work cannot cross from the blood stream into the brain due to a natural protective barrier,” said researchers in a statement.
Researchers believe that further studies are required to determine whether GDNF can reverse, slow, or stop the progression of Parkinson disease. They recommend implementation of a larger scale study that would administer higher doses of GDNF.
The study’s lead author emphasized, “It’s essential to continue research exploring this treatment further. GDNF continues to hold potential to improve the lives of people with Parkinson’s.”
Reference
Whone AL, Boca M, Luz M, et al. Extended treatment with glial cell line-derived neurotrophic factor in Parkinson’s disease. J Parkinsons Dis. 2019;9(2). doi: 10.3233/JPD-191576

Parkinson’s disease is a long-term degenerative disease that affects the central nervous system. To date, there is no cure for the condition, but there are medications and therapies available to address some of the symptoms and improve quality of life for patients.

Here are eight of the main drugs and therapies used in the treatment of Parkinson’s disease, according to the Mayo Clinic:

MORE: Discover 10 early signs of Parkinson’s disease

1. Carbidopa-levodopa: Levodopa is a naturally occurring chemical which can enter the brain and be converted to dopamine when combined with carbidopa. The carbidopa also prevents the levodopa from converting into dopamine before it enters the brain.

The is one of the most effective treatments for Parkinson’s although after long-term use, the effects start to fluctuate.

Some people may experience side effects such as nausea, feeling lightheaded, and making sudden involuntary movements.

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2. Carbidopa-levodopa infusion: In 2015, the FDA approved Duopa, which is a combination of carbidopa and levodopa in a gel form which is administered via a feeding tube into the small intestine.

Duopa is generally given to patients with advanced Parkinson’s disease whose response to carbidopa-levodopa is varied. The drug is infused continuously so the level of the drugs remains constant.

The risks associated with Duopa are infections at the site of the feeding tube and the tube falling out.

3. Dopamine agonists: Dopamine agonist mimic the effects of dopamine in the brain. They are generally not as effective as levodopa but the effects last longer and they can be used in conjunction with levodopa to counter any fluctuation in efficiency.

These medications can be administered through a patch, oral medications or as an injection. The side effects are also nausea and lightheadedness, but may also cause drowsiness, hallucinations and compulsive behaviors such as gambling, overeating, and hypersexuality — which will need to be addressed by a doctor.

MORE: Find out about the four possible causes of Parkinson’s disease here.

4. MAO-B inhinitors: Medications such as selegiline and rasagiline help to prevent dopamine breaking down in the brain by releasing monoamine oxidase B (MAO-B) enzymes.

Generally, these types of medications should not be taken in conjunction with certain narcotics or antidepressants as occasionally patients will suffer from severe reactions. Side effects of MAO-B inhibitors include insomnia and nausea and if taken with carbidopa-levodopa they can also cause hallucinations.

5. Catechol-O-methyltransferase (COMT) inhibitors: These types of medications help to prolong the effects of levodopa by blocking brain enzymes that deplete dopamine.

The side effects are the same as taking levodopa, mainly involuntary movements and diarrhea.

6. Anticholinergics: Traditionally, anticholinergics have been used over the years to help combat tremors commonly experienced in Parkinson’s disease patients.

However, side effects such as confusion, hallucinations, memory loss, constipation, and urination problems are often more troublesome than the tremors.

MORE: Seven ways to make your home safer for people with Parkinson’s disease

7. Amantadine: Amantadine can be prescribed to patients in the early stages of Parkinson’s to offer relief from their symptoms. In can also be taken in combination with carbidopa-levodopa in the later stages of the disease to help control side effects such as involuntary movements.

8. Deep brain stimulation: Most regularly used in advanced cases of Parkinson’s disease for patients who no longer respond to levodopa, deep brain stimulation involves the insertion of electrodes in the brain which are connected to a generator implanted in the chest area. The electrical pulses sent from the generator to the electrodes can reduce the symptoms of Parkinson’s disease.

The surgery carries serious risks such as brain hemorrhage, stroke, and infection. In addition, patients may need the equipment adjusting or parts replaced which involves more surgery.

MORE: Discover seven ways to help you self-manage Parkinson’s disease

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Parkinson’s disease is a degenerative illness of the nervous system that results in loss of intentional movement and impaired motor functioning. Parkinson’s disease symptoms affects smooth, natural movements of the body, and can make it hard to perform everyday tasks like speaking properly, walking, swallowing and sleeping.

With Parkinson’s, the area of the brain that controls muscular movements receives less dopamine than usual. Dopamine is an important chemical necessary for not only coordinating proper body movements, but also things like learning, increasing motivation and regulating moods. This is one reason why depression and other mood changes often affect those with Parkinson’s.

What causes Parkinson’s, and is it curable? There is no specific known cause, but some aggravating factors include exposure to certain chemicals and toxic water, plus inflammation of the brain. While there is no cure for Parkinson’s (the condition is both chronic and progressive), there are medications available to boost dopamine in the brain and help manage symptoms.

A 2016 study by researchers at the University of Saskatchewan also found a possible way to stop the progression of Parkinson’s. Researchers created caffeine-based chemical compounds — which also contained nicotine, metformin and aminoindan — that prevented the misfolding of alpha-synuclein, a protein necessary for dopamine regulation. (2)

When it comes to the effectiveness of medications and traditional drugs, often over time Parkinson’s symptoms will stop responding. This is why it’s very important to take extra measures to slow down the progression of symptoms, ideally in the early stages of the disease. Below you’ll learn about natural ways to help do this, including Parkinson’s remedies like eating an anti-inflammatory diet and exercising — both of which can effectively improve this difficult condition.

What Is Parkinson’s Disease?

Parkinson’s disease is a chronic, degenerative neurological disorder that affects older people most often, and men more often than women. (3) It’s believed to be caused by a combination of both genetic and environmental factors.

Characteristics of Parkinson’s include tremors, muscle stiffness, poor balance and difficulty walking. Although symptoms vary from person to person, with time simple tasks — like getting dressed in the morning or going to work — can often become a chore.

Because Parkinson’s disease is a chronic condition, symptoms usually persist over a long period of time and also progress with age. Each Parkinson’s patient is different, so it’s common to experience varying levels of different symptoms. For this reason, some patients respond better to certain natural treatments than others.

Symptoms and Warning Signs

Symptoms of Parkinson’s fall into two major categories: those related to motor functions, and those related to changes in someone’s mood. The four most common signs and symptoms of Parkinson’s disease include: (4)

  • Trembling: This usually presents itself in the arms, jaw, legs and face.
  • Rigidity: Most patients experience stiffness of the body’s core (trunk area) as well as their arms and legs.
  • Bradykinesia: This is the term for slowness of movement. Some patients pause or freeze when moving without being able to start again, and others begin to shuffle when trying to walk.
  • Postural instability (poor posture): This results in loss of strength, loss of balance and problems with moving muscles or coordinating body parts.

Other symptoms that can also occur, which often impact someone’s moods and other behaviors, include:

  • Depression and fatigue
  • Urinary problems
  • Trouble speaking or eating normally
  • Digestive issues, including constipation
  • Trouble sleeping
  • Skin problems
  • Voice changes
  • Sexual dysfunction

Risk Factors and Causes

There isn’t one single cause of Parkinson’s that has been proven at this time. Researchers believe a loss of the neurotransmitter dopamine, neurological damage, inflammation and brain cell deterioration are among the primary factors that trigger Parkinson’s development. But why exactly patients develop these problems is a complex issue that remains up for debate.

What is known is that certain risk factors can make someone more susceptible to developing Parkinson’s disease, which can include: (5)

  • Being a man, especially during older age. Research suggests that men in their 50s and 60s are most likely to develop Parkinson’s.
  • Genetic susceptibility: Studies have now identified several gene mutations that can put someone at a greater risk. Parkinson’s has also been found to run in families, and having a sibling or parent increases someone’s risk.
  • Damage to the area of the brain called the “substantia nigra,” which produces brain cells that are responsible for making dopamine.
  • Toxicity and exposure to chemicals, including pesticides present on produce from non-organic farming. Living in a rural area and drinking well-water that might contain chemicals is another environmental risk factor.
  • Poor diet, nutrient deficiencies, food allergies and an unhealthy lifestyle.
  • Hormonal imbalances and other medical conditions that affect cognitive health and increase inflammation.

Conventional Treatment

Although they are not the only option, pharmaceutical drugs can be used to help stabilize a Parkinson’s patient’s moods and improve motor control. Parkinson’s treatments can be classified into three general categories: (6)

  • Symptomatic treatments: these include pharmaceuticals such as levodopa (L-dopa), Inosine and Carbidopa, which increase the production of dopamine in the brain. Less common drugs that are also sometimes used to control symptoms include bromocriptine, pramipexole and ropinirole.
  • Neuro-protective treatments: These can include surgeries such as Deep Brain Stimulation (DBS) or tissue removal.
  • Cure-based strategies: These are still being investigated and are the future of Parkinson’s treatments. The latest research shows that natural treatments for Parkinson’s, described below, can greatly help lower someone’s risk and also improve quality of life in Parkinson’s patients.

Specifically with DBS, a clinical trial published in 2018 has shown that behavioral outcomes are better in young patients who are treated using traditional deep brain stimulation with medication than with medication alone. Of the 251 participants, 124 were assigned to receive medical therapy plus bilateral subthalamic stimulation. At the two-year follow-up period, the medicine dosage decreased by 39 percent. Additionally, neuropsychiatric fluctuations (or mood disturbances) decreased with this group. Of the 124 participants who only received medical therapy, medicine dosage increased by 21 percent and mood disturbances did not alter. (7)

While we’re still discussing DBS, a 2017 clinical study highlighted that adaptive deep brain stimulation could potentially be more efficient, impactful and specific versus traditional deep brain stimulation. The study states, “adaptive deep brain stimulation uses feedback about the state of neural circuits to control stimulation rather than delivering fixed stimulation all the time, as currently performed.” Both adaptive and traditional DBS suppressed activity in the subthalamic nucleus in the brain, adaptive DBS achieves a greater suppression due to its shorter burst duration. (8)

Natural Treatments

Best Foods for Parkinson’s

It’s important for Parkinson’s patients to eat a whole foods, nutrient-dense diet that includes plenty of fresh organic fruit, vegetables and high-quality meats. Removing processed foods and those that contain preservatives, synthetic ingredients and other chemicals is also very beneficial.

To improve this condition, start with a healthy Parkinson’s disease diet that includes the following foods:

  • Raw foods: Raw fruits and vegetables provide antioxidants to help reduce free radical damage and lower inflammation.
  • High fiber foods: Constipation is common among Parkinson’s patients, so be sure to eat plenty of fiber and also stay adequately hydrated to help improve bowel functions.
  • Healthy Fats: Consuming healthy fats can support neurological health and help prevent worsening moods. Add in foods like wild-caught fish, avocado, coconut, pastured butter, and sprouted nuts or seeds like walnuts and flax.
  • Cold-pressed oils: Olive oil used as salad dressing can provide essential vitamin E, which acts as an antioxidant. Coconut oil and palm oil are also beneficial oils to include in your diet since they have anti-inflammatory effects.
  • Omega-3 foods: Increasing omega-3 intake can help elevate dopamine levels and reduce inflammation. Focus on consuming wild seafood several times weekly, as well as including nuts and seeds in your diet.
  • Fresh vegetable juices: These help provide essential vitamins and mineral. Fresh juice is also hydrating and can help with constipation.
  • Having protein at dinner only: Keeping protein levels moderate throughout the day has been shown to help reduce the symptoms of Parkinson’s. (9)
  • Green Tea: Green tea contains polyphenol antioxidants that help fight free radicals. It also contains theanine, which elevates dopamine levels in the brain. Try drinking three cups a day to reap the most benefits.
  • Many people also benefit from eliminating grains completely.
  • For more details on increasing intake of nutrient-dense foods, check out the Healing Foods Diet Plan.

Foods to Avoid

  • Too much protein: Reducing protein intake can improve the symptoms of Parkinson’s.
  • Processed foods: Toxins and additives found in these foods can make Parkinson’s worse. Removing these from a young age is also a preventative step that lowers risk for other age-related illnesses too.
  • Artificial sweeteners & added sugar: These are considered toxic and can make Parkinson’s symptoms worse.
  • Alcohol: Can disrupt neurologic functioning and contribute to mood changes or complications.
  • Any potential food allergens: Food allergies may exacerbate Parkinson’s symptoms by worsening gut health and inflammation. Start by limiting the common allergens that include gluten, dairy, shellfish and peanuts.

Supplements and Essential Oils

  • Coenzyme Q10 (1,200 milligrams daily): A powerful antioxidant that can help slow the progression of Parkinson’s disease. Studies have shown that very low levels of coenzyme Q10 in the brain and blood of Parkinson’s patients. Mitochondria are responsible for the production of energy for our cells, but during production, a by-product of spare electrons is created. When these electrons escape the cell, they are known as free radicals that are responsible for oxidative damage to the brain and linked to cognitive problems. To combat the damage, every cell of the body contains a powerful antioxidant called coenzyme Q10, but people with high levels of oxidative damage can afford to consume even more.
  • Vitamin C (750 milligrams, 4x daily): Can be used as an antioxidant to prevent free radical damage. Also supports strong immune function.
  • Vitamin E (400 IU daily): An important antioxidant that supports the brain.
  • Green vegetables powder supplement: Make sure the formula includes spirulina, chlorella or wheatgrass to provide critical minerals and help with detoxification.
  • Omega-3 fish oil (1,000 milligrams daily): Helps reduce inflammation and supports neurological health.
  • Vitamin D: To maintain bone health, make sure your diet includes plenty of calcium and vitamin D. People who are over the age of 50 should consume 1,500 milligrams of calcium daily along with at least 800 IU of vitamin D (from the sun, foods and supplements).
  • Essential oils for Parkinson’s: Using essential oils may effectively reduce and calm some of the symptoms associated with Parkinson’s disease such as depression, sleep trouble, skin inflammation and digestive issues. Helichrysum and frankincense oil have been shown to reduce inflammation of the brain, and vetiver oil has been found to reduce tremors. Rub 2 drops frankincense, helichrysum and vetiver oil on the temples and neck two times daily or put 2 drops of frankincense on the roof of the mouth.

Exercises and Other Movement Remedies

Washington University School of Medicine reports that exercise is the forefront of Parkinson’s treatment. (11) While people with Parkinson’s are not always able to exercise the way they once did before the disease, studies have actually found that most can retain the ability to participate in many forms of exercise just as well as age-matched subjects without the disease. In those who might be at risk for Parkinson’s but have not yet developed symptoms, research suggests that “midlife exercise significantly reduces the later risk of both dementia and other mild cognitive impairments.” (12)

Numerous studies now show that exercise seems to have many anti-inflammatory, antidepressant and neuroprotective mechanisms that improve cognitive health. Animal studies have revealed many exercise-related protective effects including reductions in dopaminergic neurotoxins, improved brain neurotrophic factors and improved neuroplasticity.

1. Move With Caution

Parkinson’s can throw off someone’s sense of balance and make it difficult to walk with a normal gait. Here are tips that can make movement safer and a bit easier:

  • Try not to move too quickly, and consider using a supportive cane or device when needed.
  • When you’re walking, try to make sure your heel hits the floor first. Work on rolling through your feet as you move forward.
  • If you find yourself shuffling, stop and adjust your posture.
  • Look straight ahead as you walk, not down at the ground. When turning around, resist the tendency to pivot at your feet. Instead, make a U-turn.
  • Try to avoid leaning or reaching and keep your center of gravity over your feet.

2. Stretch to Prevent Stiff Muscles

Gentle exercise and stretching make everyday tasks easier. They can also help reduce stiffness, soreness and pain. Here’s a simple four-step sequence you can do daily to keep loose and prevent muscle spasms or pain:

  1. Stand eight inches away from a wall and reach your arms upward. Place your hands on the wall for balance and stretch out your arms and back.
  2. Next, turn around and place your back against the wall for balance. Gently march in place, lifting your knees as high as possible.
  3. Sitting in a chair, reach your arms behind the chair, bringing your shoulders back as far as possible. Lift your head toward the ceiling as you stretch.
  4. From the chair, stomp your feet up and down while pumping your arms back and forth at your sides.

3. Practice Mind-Body Exercises Like Tai Chi

Tai chi is the Chinese martial art of slow, rhythmic movement. Research conducted by the Department of Rehabilitation Medicine at West China Hospital shows that in Parkinson’s patients, tai chi is great for maintaining strength and balance, reducing risk for falls, and can also helps alleviate anxiety or depression. (13)

Long recommended as a way for seniors to stay active and fit, research is now suggesting it can help manage Parkinson’s symptoms by improving range of motion, balance and focus. An hour of tai chi twice a week is recommended for helping with stability, coordination and tasks like walking.

4. Participate in Water Aerobics

Trouble balancing, muscle loss, strength decline and stiffness can make traditional exercises difficult. Water aerobics can have the same benefits as other types of conventional exercise without the risk of falling.

A study published in the Journal of Physical Therapy Science showed that older adults who participated in water sports had significant increases in leg strength, better recovery of balance after falls, significant improvements in gait patterns and lowered risk of future injuries from falling. (14) Be sure to use the shallow end of the pool to avoid accidents, and try having a buddy come along for extra motivation and support. Joining a group class might be beneficial for emotional support and additional motivation.

Try Acupuncture

According to the Neurodegenerative Disease Research Group at King’s College in London, recent research has shown acupuncture can relieve Parkinson’s symptoms by generating a neural response in areas of the brain that are particularly affected by inflammation, such as the putamen and the thalamus.

Acupuncture has been used for centuries to help reduce pain, anxiety, insomnia and stiffness. Now it’s suggested that it can even help slow cell death and attenuate oxidative stress that causes damage to dopaminergic neurons in the substantia nigra. (15)

Precautions

The natural treatments mentioned above cannot guarantee that someone is protected from Parkinson’s, or control all symptoms of the disease in all patients. Unfortunately, due to the unpredictability of Parkinson’s disease symptoms, it often makes the disease hard to diagnose and treat in many cases.

If you start to notice gradual changes in your movement control and moods, it might be wise to speak with a doctor about your symptoms, especially if cognitive disorders run in your family. The National Parkinson’s Foundation offers resources for spotting the disease in its earliest stages and recommends considering testing if you experience such changes as loss of smell, sight, grip, stability, or ability to go to the bathroom and walk normally.

Final Thoughts

  • Symptoms of Parkinson’s include trembling, loss of balance, slowed movements, mood changes, poor posture and lack of motor control.
  • Causes of Parkinson’s include high levels of inflammation, brain cell deterioration, low dopamine levels, high pesticide/toxin exposure and possibly genetic factors.
  • Natural remedies to help manage Parkinson’s symptoms include eating a healthy diet, taking supplements such as coenzyme Q10, vitamins C, D and E and fish oil, participating in physical and occupational therapy, exercising and stretching as well as using essential oils and mind-body practices to help manage stress.

Read Next: Lewy Body Dementia: The Cognitive Disorder You May Not Know About

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Parkinson disease

Treatment Options

Exercise, especially intensive exercise, has been shown to improve symptoms and help maintain balance and mobility. Walking, swimming, jogging, or even dancing 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.

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.

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 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

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.

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 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

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.

Movement Therapies

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.

Mind-Body Therapies

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 and Acupuncture

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.

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