Opinion statement
No conventional treatment has been convincingly demonstrated to slow or stop the progression of Parkinson’s disease (PD). Dopaminergic therapy is the gold standard for managing the motor disability associated with PD, but it falls short of managing all of the aspects of the disease that contribute to quality of life. Perhaps for this reason, an increasing number of patients are searching for a more holistic approach to healthcare. This is not to say that they are abandoning the standard and effective symptomatic therapies for PD, but rather are complementing them with healthy living, mind-body practices, and natural products that empower patients to be active participants in their healthcare and widen the net under which disease modification might one day be achieved. Despite high rates of utilization of complementary and alternative medicine (CAM) practices, data on efficacy is generally limited, restricting physicians in providing guidance to interested patients. Exercise is now well-established as integral in the management of PD, but mind-body interventions such as Tai Chi that incorporate relaxation and mindfulness with physical activity should be routinely encouraged as well. While no comment can be made about neuroplastic or disease-modifying effects of mind-body interventions, patients should be encouraged to be as active as possible and engage with others in enjoyable and challenging activities such as dance, music therapy, and yoga. Many PD patients also choose to try herbs, vitamins, and neutraceuticals as part of a healthy lifestyle, with the added expectation that these products may lower free radical damage and protect them against further cell death. Evidence for neuroprotection is limited, but patients can be encouraged to maintain a healthy diet rich in “high-power,” low-inflammatory foods, while at the same time receiving education that many promising natural products have produced disappointing results in clinical trials. It is vital that the science of holistic medicine reaches a point where all neutraceuticals are investigated with the same rigor as conventional drugs. A number of agents discussed here that have a proposed role in the treatment of neurodegenerative diseases (and PD in particular), including cannabis, mucuna pruriens, and Chinese herbals, deserve more attention from basic science researchers and clinical investigators before they can be either safely utilized or dismissed.
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References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
Global Parkinson’s Disease Survey Steering Committee. Factors impacting on quality of life in Parkinson’s disease: results from an international survey. Mov Disord. 2002;17(1):60–7.
Hely MA, Morris JG, Reid WG, et al. Sydney Multicenter Study of Parkinson’s disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2005;20(2):190–9.
Rajendran PR, Thompson RE, Reich SG. The use of alternative therapies by patients with Parkinson’s disease. Neurology. 2001;57(5):790–4.
Kim JY, Jeon BS. Complementary and alternative medicine in Parkinson’s disease patients in Korea. Curr Neurol Neurosci Rep. 2012;12(6):631–2.
Lökk J, Nilsson M. Frequency, type and factors associated with the use of complementary and alternative medicine in patients with Parkinson’s disease at a neurological outpatient clinic. Parkinsonism Relat Disord. 2010;16(8):540–4.
Wang Y, Xie CL, Wang WW, et al. Epidemiology of complementary and alternative medicine use in patients with Parkinson’s disease. J Clin Neurosci. 2013;20(8):1062–7. This review describes the worldwide use of CAM practices and identifies important issues with regard to CAM use which require more attention.
French J, Gronseth G. Lost in a jungle of evidence: we need a compass. Neurology. 2008;71(20):1634–8.
Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med. 2012;366(6):511–9. This study provided strong evidence that Tai Chi reduced balance impairments, improved functional capacity, and reduced falls in patients with PD compared to other active interventions.
Amano S, Nocera JR, Vallabhajosula S, et al. The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson’s disease. Parkinsonism Relat Disord. 2013;19(11):955–60.
Gao Q, Leung A, Yang Y, et al. Effects of Tai Chi on balance and fall prevention in Parkinson’s disease: a randomized controlled trial. Clin Rehabil. 2014;28(8):748–53.
Choi HJ, Garber CE, Jun TW, et al. Therapeutic effects of Tai Chi in patients with Parkinson’s disease. ISRN Neurol. 2013;2013:548240.
Cheon SM, Chae BK, Sung HR, et al. The efficacy of exercise programs for Parkinson’s disease: Tai Chi versus combined exercise. J Clin Neurol. 2013;9:237–43.
Nocera JR, Amano S, Vallabhajosula S, et al. Tai Chi exercise to improve non-motor symptoms of Parkinson’s disease. J Yoga Phys Ther. 2013. doi:10.4172/2157-7595.1000137.
Hackney ME, Earhart GM. Tai Chi improves balance and mobility in people with Parkinson disease. Gait Posture. 2008;456–60.
Schmitz-Hübsch T, Pyfer D, Kielwein K, et al. Qigong exercise for the symptoms of Parkinson’s disease: a randomized, controlled pilot study. Mov Disord. 2006;21(4):543–8.
Burini D, Farabollini B, Iacucci S, et al. A randomised controlled cross-over trial of aerobic training versus Qigong in advanced Parkinson’s disease. Eura Medicophys. 2006;42(3):231–8.
Hackney ME, Kantorovich S, Levin R, et al. Effects of tango on functional mobility in Parkinson’s disease: a preliminary study. J Neurol Phys Ther. 2007;31(4):173–9.
Foster ER, Golden L, Duncan RP, et al. Community-based Argentine tango dance program is associated with increased activity participation among individuals with Parkinson’s disease. Arch Phys Med Rehabil. 2013;94(2):240–9.
Duncan RP, Earhart GM. Randomized controlled trial of community-based dancing to modify disease progression in Parkinson disease. Neurorehabil Neural Repair. 2012;26(2):132–43.
Hackney ME, Earhart GM. Effects of dance on movement control in Parkinson’s disease: a comparison of Argentine tango and American ballroom. J Rehabil Med. 2009;41(6):475–81.
Hackney ME, Earhart GM. Effects of dance on gait and balance in Parkinson’s disease: a comparison of partnered and nonpartnered dance movement. Neurorehabil Neural Repair. 2010;24(4):384–92.
Volpe D, Signorini M, Marchetto A, et al. A comparison of Irish set dancing and exercises for people with Parkinson’s disease: a phase II feasibility study. BMC Geriatr. 2013;13:54.
Pacchetti C, Mancini F, Aglieri R, et al. Active music therapy in Parkinson’s disease: an integrative method for motor and emotional rehabilitation. Psychosom Med. 2000;62(3):386–93.
de Bruin N, Doan JB, Turnbull G, et al. Walking with music is a safe and viable tool for gait training in Parkinson’s disease: the effect of a 13-week feasibility study on single and dual task walking. Park Dis. 2010:483530.
Colgrove YS, Sharma N, Kluding P, et al. Effect of yoga on motor function in people with Parkinson’s disease: a randomized, controlled pilot study. J Yoga Phys Ther. 2012;2(112).
Nanhoe-Mahabier W, Allum JH, Pasman EP, et al. The effects of vibrotactile biofeedback training on trunk sway in Parkinson’s disease patients. Parkinsonism Relat Disord. 2012;18(9):1017–21.
Mohr B, Müller V, Mattes R, et al. Behavioral treatment of Parkinson’s Disease leads to improvement of motor skills and to tremor reduction. Behav Ther. 1996;27(2):235–55.
Pickut BA, Van Hecke W, Kerckhofs E, et al. Mindfulness based intervention in Parkinson’s disease leads to structural brain changes on MRI: a randomized controlled longitudinal trial. Clin Neurol Neurosurg. 2013;115(12):2419–25. This study used brain MRI voxel-based morphometry to make a quantitative analysis of the neurobiological effects of mindfulness based intervention in PD.
Tamir R, Dickstein R, Huberman M. Integration of motor imagery and physical practice in group treatment applied to subjects with Parkinson’s disease. Neurorehabil Neural Repair. 2007:68–75.
Braun S, Beurskens A, Kleynen M, et al. Rehabilitation with mental practice has similar effects on mobility as rehabilitation with relaxation in people with Parkinson’s disease: a multicentre randomised trial. J Physiother. 2011;57(1):27–34.
Stallibrass C, Sissons P, Chalmers C. Randomized controlled trial of the Alexander technique for idiopathic Parkinson’s disease. Clin Rehabil. 2002;16(7):695–708.
Craig LH, Svircev A, Haber M, et al. Controlled pilot study of the effects of neuromuscular therapy in patients with Parkinson’s disease. Mov Disord. 2006;21(12):2127–33.
Cho SY, Shim SR, Rhee HY, et al. Effectiveness of acupuncture and bee venom acupuncture in idiopathic Parkinson’s disease. Parkinsonism Relat Disord. 2012;18(8):948–52.
Cristian A, Katz M, Cutrone E, et al. Evaluation of acupuncture in the treatment of Parkinson’s disease: a double-blind pilot study. Mov Disord. 2005;20(9):1185–8.
Wang L, He C, Liu Y, et al. Effect of acupuncture on the auditory evoked brain stem potential in Parkinson’s disease. J Tradit Chin Med. 2002;22(1):15–7.
Parkinson Study Group. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson’s disease. N Engl J Med. 1993;328(3):176–83.
NINDS NET-PD Investigators. A randomized clinical trial of coenzyme Q10 and GPI-1485 in early Parkinson disease. Neurology. 2007;68(1):20–8.
Storch A, Jost WH, Vieregge P, et al. Randomized, double-blind, placebo-controlled trial on symptomatic effects of coenzyme Q(10) in Parkinson disease. 2007;64(7):938–44.
Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. 2002;59(10):1541–50.
Investigators Parkinson Study Group QE3. A randomized clinical trial of high-dosage coenzyme q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol. 2014;71(5):543–52. This was a large phase III randomized controlled trial demonstrating the lack of efficacy of coenzyme q10 in slowing disease progression in PD.
Investigators NINDS NET-PD. A randomized, double-blind, futility clinical trial of creatine and minocycline in early Parkinson disease. Neurology. 2006;66(5):664–71.
ClinicalTrials.gov. [Online]. Available from: HYPERLINK “http://clinicaltrials.gov/ct2/show/NCT00449865”.
Hauser RA, Lyons KE, McClain T, et al. Randomized, double-blind, pilot evaluation of intravenous glutathione in Parkinson’s disease. Mov Disord. 2009;24(7):979–83.
Investigators Parkinson Study Group SURE-PD. Inosine to increase serum and cerebrospinal fluid urate in Parkinson disease: a randomized clinical trial. JAMA Neurol. 2014;71(2):141–50. This was a phase II trial demonstrating the safety, tolerability, and urate-elevating capability of inosine in PD. A phase III efficacy trial to determine whether inosine can slow disease progression in PD is expected.
Katzenschlager R, Evans A, Manson A, et al. Mucuna pruriens in Parkinson’s disease: a double blind clinical and pharmacological study. J Neurol Neurosurg Psychiatry. 2004;75(12):1672–7.
Sieradzan KA, Fox SH, Hill M, et al. Cannabinoids reduce levodopa-induced dyskinesia in Parkinson’s disease: a pilot study. Neurology. 2001;57(11):2108–11.
Carroll CB, Bain PG, Teare L, et al. Cannabis for dyskinesia in Parkinson disease: a randomized double-blind crossover study. Neurology. 2004;63(7):1245–50.
Modugno N, Iaconelli S, Fiorlli M, et al. Active theater as a complementary therapy for Parkinson’s disease rehabilitation: a pilot study. Sci World J. 2010:2301–13.
Heiberger L, Maurer C, Amtage F, et al. Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson’s disease. Front Aging Neurosci. 2011;eCollection 2011:3–14.
Marchant D, Sylvester JL, Earhart GM. Effects of a short duration, high dose contact improvisation dance workshop on Parkinson disease: a pilot study. Complement Ther Med. 2010;18(5):184–90.
Chanda ML, Levitin DJ. The neurochemistry of music. Trends Cogn Sci. 2013;17(4):179–93.
Knight WE, Rickard PhD NS. Relaxing music prevents stress-induced increases in subjective anxiety, systolic blood pressure, and heart rate in healthy males and females. J Music Ther. 2001;38(4):254–72.
Möckel M, Röcker L, Störk T, et al. Immediate physiological responses of healthy volunteers to different types of music: cardiovascular, hormonal and mental changes. Eur J Appl Physiol Occup Physiol. 1994;68(6):451–9.
Menon V, Levitin DJ. The rewards of music listening: response and physiological connectivity of the mesolimbic system. Neuroimage. 2005;28(1):175–84.
Advocat J, Russell G, Enticott J, et al. The effects of a mindfulness-based lifestyle programme for adults with Parkinson’s disease: protocol for a mixed methods, randomised two-group control study. BMJ Open. 2013;3(10):e003326.
Gaser C, Schlaug G. Brain structures differ between musicians and non-musicians. J Neurosci. 2003;23(27):9240–5.
Berkowitz AL, Ansari D. Generation of novel motor sequences: the neural correlates of musical improvisation. Neuroimage. 2008;41(2):535–43.
Arias P, Cudeiro J. Effect of rhythmic auditory stimulation on gait in Parkinsonian patients with and without freezing of gait. PLoS One. 2010;5(3):e9675.
Thaut MH, McIntosh GC, Rice RR, et al. Rhythmic auditory stimulation in gait training for Parkinson’s disease patients. Mov Disord. 1996;11(2):193–200.
Bernatzky G, Bernatzky P, Hesse HP, et al. Stimulating music increases motor coordination in patients afflicted with Morbus Parkinson. Neurosci Lett. 2004;361(1–3):4–8.
Hagins M, States R, Selfe T, et al. Effectiveness of yoga for hypertension: systematic review and meta-analysis. Evid Based Complement Alternat Med. 2013:649836.
Cramer H, Lauche R, Haller H, et al. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013;29(5):450–60.
Streeter CC, Gerbarg PL, Saper RB, et al. Effects of yoga on the autonomic nervous system, gamma-aminobutyric acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses. 2012;78(5):571–9.
Schlesinger I, Benyakov O, Erikh I, et al. Parkinson’s disease tremor is diminished with relaxation guided imagery. Mov Disord. 2009;24(14):2059–62.
Hofmann SG, Sawyer AT, Witt AA, et al. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2):169–83.
Advocat J, Russell G, Enticott J, et al. The effects of a mindfulness-based lifestyle programme for adults with Parkinson’s disease: protocol for a mixed methods, randomised two-group control study. BMJ Open. 2013;3(10):e003326.
Donoyama N, Ohkoshi N. Effects of traditional Japanese massage therapy on various symptoms in patients with Parkinson’s disease: a case-series study. J Altern Complement Med. 2012;18(3):294–9.
Paterson C, Allen JA, Browning M, et al. A pilot study of therapeutic massage for people with Parkinson’s disease: the added value of user involvement. Complement Ther Clin Pract. 2005;11(3):161–71.
Yeo S, Lim S, Choe IH, et al. Acupuncture stimulation on GB34 activates neural responses associated with Parkinson’s disease. CNS Neurosci Ther. 2012;18(9):781–90.
Eng ML, Lyons KE, Greene MS, et al. Open-label trial regarding the use of acupuncture and yin tui na in Parkinson’s disease outpatients: a pilot study on efficacy, tolerability, and quality of life. J Altern Complement Med. 2006;12(4):395–9.
Shulman LM, Wen X, Weiner WJ, et al. Acupuncture therapy for the symptoms of Parkinson’s disease. Mov Disord. 2002;17(4):799–802.
Ren XM. Fifty cases of Parkinson’s disease treated by acupuncture combined with madopar. J Tradit Chin Med. 2008;28(4):255–7.
Lee HS, Park HL, Lee SJ, et al. Scalp acupuncture for Parkinson’s disease: a systematic review of randomized controlled trials. Chin J Integr Med. 2013;19(4):297–306.
Sechi G, Deledda MG, Bua G. Reduced intravenous glutathione in the treatment of early Parkinson’s disease. Prog Neuropsychopharmacol Biol Psychiatry. 1996;20(7):1159–70.
Holmay MJ, Terpstra M, Coles LD, et al. N-Acetylcysteine boosts brain and blood glutathione in Gaucher and Parkinson diseases. Clin Neuropharmacol. 2013;36(4):103–6.
Cipriani S, Desjardins CA, Burdett TC, et al. Urate and its transgenic depletion modulate neuronal vulnerability in a cellular model of Parkinson’s disease. PLoS One. 2012;7(5):e37331.
Gong L, Zhang QL, Zhang N, et al. Neuroprotection by urate on 6-OHDA-lesioned rat model of Parkinson’s disease: linking to Akt/GSK3β signaling pathway. J Neurochem. 2012;123(5):876–85.
Ascherio A, LeWitt PA, Xu K, Eberly S, et al. Urate as a predictor of the rate of clinical decline in Parkinson disease. Arch Neurol. 2009;66(12):1460–8.
Lotan I, Treves TA, Roditi Y, et al. Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: an open-label observational study. Clin Neuropharmacol. 2014:41–4.
Lo YC, Shih YT, Tseng YT. Neuroprotective effects of San-Huang-Xie-Xin-Tang in the MPP(+)/MPTP models of Parkinson’s disease in vitro and in vivo. Evid Based Complement Alternat Med. 2012;2012:501032.
Li Q, Zhao D, Bezard E. Traditional Chinese medicine for Parkinson’s disease: a review of Chinese literature. Behav Pharmacol. 2006;17(5):403–10.
Zhang J, Ma YZ, Shen XM. Evaluation on the efficacy and safety of Chinese herbal medication Xifeng Dingchan Pill in treating Parkinson’s disease: study protocol of a multicenter, open-label, randomized active-controlled trial. J Integr Med. 2013;11(4):285–90.
Chen H, Zhang SM, Schwarzschild MA, et al. Physical activity and the risk of Parkinson disease. Neurology. 2005;64(4):664–9.
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Conflict of InterestDanny Bega has received a junior investigator award from the Northwestern University Parkinson’s Disease Advisory Council to study the efficacy of yoga in Parkinson’s disease.
Paulina Gonzalez-Latapi declares no conflict of interest.
Cindy Zadikoff has served as a paid consultant for UCB Pharma, AbbVie, and Merz. She has also served as a paid speaker for Teva and GSK.
Tanya Simuni has served as a paid consultant and has received honoraria from Novartis, Ibsen, General Electric, UCB Pharma, TEVA, IMPAX, Merz, Boehringer Ingelheim, National Parkinson Foundation, and GSK (terminated April 2009). She has also received research support from NIH, MJ Fox Foundation, TEVA, IMPAX, National Parkinson Foundation, and Northwestern Memorial Foundation.
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Bega, D., Gonzalez-Latapi, P., Zadikoff, C. et al. A Review of the Clinical Evidence for Complementary and Alternative Therapies in Parkinson’s Disease. Curr Treat Options Neurol 16, 314 (2014). https://doi.org/10.1007/s11940-014-0314-5
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DOI: https://doi.org/10.1007/s11940-014-0314-5