Parkinson's Disease

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Latest Edit: Hector 2014-05-13 (EDT)

Parkinson's Disease (PD) affects nearly 1% of individuals over 60. It is characterized by resting tremors, rigidity, slow movement, inability to move, foot shuffling, and postural reflex impairment caused by the destruction of dopaminergic neurons. Parkinson's has a complex etiology and subsequently there have been many factors indicated in its development and progression. [1]

Parkinson's Disease
Parkinsons.jpg

Parkinson's Disease
Causes Environmental Toxins, Smoking, Infections, Dietary Factors, Prescription Medications
See Also Neurological Conditions, Sleep disorders, Depression
Books Books on Neurological Conditions
Articles Articles on Neurological Conditions
Article Parkinson Disease, NDNR; 2012 April

Naturopathic Assessment

Article Parkinson's Disease, An eclectic approach , IHP ; Nov/Dec 2012
Check out this book Natural Therapies for Parkinson's Disease
Check out this book Parkinson Disease: A Naturopathic Approach


Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. In Parkinson's Disease the causes are variable with environmental factors playing a key role. A detailed assessment is required to determine which factors are contributing to the development and progression of PD.

Lifestyle

External

  • Smoking: Interestingly, epidemiological evidence suggests a protective effect of smoking on PD risk. Of course the risks of cigarette smoking are many, and smoking is discouraged in all populations.[2]

Environmental

  • There is a known link to living in rural areas of industrialized countries and drinking well water, and Parkinson's disease.
  • Exposure to MPTP, a product in pesticides and found in synthetic heroin, has been shown to cause Parkinson's like symptoms. This evidence, along with the abundance of similar chemicals in the environment, suggests a probable link between pesticide exposure and PD.[4]
  • Solvent exposure: Studies involving metal and solvent exposure and PD have demonstrated that individuals regularly exposed to solvents for extended periods of time have a 400% increase in incidence of PD. It is unclear how stricter control in industry and the decreased use of older solvents has affected PD risk.[4]
  • Exacerbation of symptoms may be associated with an acute infection, especially in the more advanced stages of the disease.[5]

Medical Interventions

  • Prescription Medications
  • Drug induced Parkinsonism may be caused by the following medications:
  • Antipscyhotics including: Haloperidol, Chlorpromazine, Trifuloperazine, Amoxapine, Risperidone, Olanzapine, Ziprasidone, Reserpine, Quetiapine, Clozapine.
  • Antinausea medications including: Metoclopramide, Prochlorperazine
  • Antiseizure medications including: Valproate
  • Antirejection medications including: Cyclosporine
  • Antidysrhythmic medications including: Amiodarone [2]

Genetics

  • There is some evidence of increased risk for relatives of patients with PD, but overall there seems to be a relatively low amount of genetic suceptibility involved in PD development. [6] The genetic link may be more to due to a common environmental exposure.

Diagnostic Testing

Parkinson's Disease can be confirmed by the presence of two of the following three clinical signs:[1]

  1. Resting tremor, including either pill rolling or hand oscillation.
  2. Increased rigidity noted by resistance to passive movement around a joint.
  3. Slowness of movement known as Bradykinesia.

Related Symptoms and Conditions

Diseases related to Parkinson's Disease include:[4]

  • Parkinsonism plus syndrome which occurs when typical PD symptoms co-occur with other abnormal neurologic symptoms. The most common additional neurologic symptoms include: abnormal eye movements, dystonia, and dysphagia.
  • Shy-Drager syndrome is characterized by normal PD symptomology accompanied by autonomic nervous system symptoms including: peripheral polyneuropathy, spasticity, and anterior horn cell dysfunciton.

Health conditions associated with PD include:[2]

Characteristics

Parkinson's disease is characterized by the formation of Lewy bodies in dopaminergic neurons leading to cell death. Lewy bodies are formed by a build-up of alpha synuclein protein which should normally be broken down before accumulation.

  • Motor symptoms associated with PD are caused by degeneration of the nigrostrial dopaminergic neurons. [2]

Common Symptoms

Parkinson's Disease commonly presents with the following signs and symptoms:[4]

  • Resting tremors that are worse when at rest, and better with movement
  • Pill rolling motion of thumb and index finger
  • Slow movement or inability to move
  • Challenges intitiating movement
  • Shuffling gate
  • Rigidity of limbs
  • Fixed or reduced facial expressions
  • Small handwriting
  • Dysphagia

Naturopathic Treatment

Article Parkinson's disease: Contemporary and natural therapeutic interventions, IHP, April/May 2010

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. Parkinson's Disease is a chronic disease with a complex course and treatment must include frequent follow up and adjustment. It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Home Care

Due to the many physical challenges of PD the following home modifications are recommended:[4]

  • Install banisters along walls
  • Use chairs with higher arms to ease sitting
  • Install thick carpets to avoid falls

Increasing amounts of assisted home care may be needed based on the clinical progression of PD. Individuals may need increasing assistance with activities of daily living.

Lifestyle

Lifestyle recommendations include:

  • Eliminate alcohol, caffeine and sugar.[4]
  • Identify and control food allergies and food intolerances.[4]
  • Consume a diet that focuses on whole unprocessed food (whole grains, legumes, vegetables, nuts and seeds).[4]
  • Higher levels of serum urate (SU) may have a neuroprotective effect. High serum urate levels reduced the risk of developing Parkinson's disease and correlated with slower progression. Among Parkinson's disease patients serum urate levels were lower as compared with controls. It is possible that a high purine diet in patients with Parkinson's disease may slow progression of the disease. Milk and meat consumption as well as exercise modify the risk of developing Parkinson's disease possibly through their influence on serum urate levels.[7]
  • Low protein diets facilitate levodopa's ability to enter brain tissue. Consumption of protein should be limited to 10% of total calories, and most protein should be consumed at dinner.[1]
  • Increased intake of insoluble fiber facilitates the bioavailability of levodopa. Insoluble fiber also helps to normalize bowel function and prevent constipation, which common occurs in patients with PD.[1]
  • Food Source Levodopa can be incorporated into diets and has been shown to be effective in the treatment of PD. The must abundant food source of levodopa is fava beans. Use of food source levodopa should be discussed with a health care practitioner.[4]
  • Ensure you drink adequate water.
  • Ongoing vigorous exercise and physical fitness should be highly encouraged. PD physical therapy programs should include structured, graduated fitness instruction and guidance for deconditioned patients with PD. Studies have demonstrated significant benefit to regular exercise with respect to balance, gait, activities of daily living, and quality of life.[8],
  • Tai chi and postural stability in patients with Parkinson's disease. [9]
  • Water based exercise training programs are a helpful therapy in PD. Muscular resistance programs of this kind seem to be of value in improving PD patients functional mobility, motor symptoms and QoL.[10]
  • Changes in posture are often noted in PD, and can be addressed and improved with appropriate physiotherapeutic treatments.
  • Motor dysfunction in PD can manifest with respiratory symptoms. Preliminary studies suggest respiratory muscle weakness may be implicated in this dysfunction, and techniques used to strengthen respiratory muscles can potentially benefit breathing, swallowing, and speech functions in PD patients. [11]
  • Improvement in PD symptoms can be noted with relaxation, and exacerbated with anxiety. Strategies to reduce stress including hypnosis have been demonstrated to have benefit in the treatment of PD. [4]

Naturopathic Therapies

The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal factors, a person's age, prescription medications, other conditions and symptoms and overall health. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies.

Naturopathic Therapies for Parkinson's Disease include:

Article Coenzyme Q10 and Parkinson Disease, J Orthomolecular Med 2012;Vol27(3)
Article Homocysteine, CoQ10, and Parkinson's Disease, NMJ, [1], 2012 March
Article Efficacy of Vitamin B3 and its related Coenzymes for the Treatment of Bell's Palsy, Huntington's Disease, Migrain and Chronic Tension-Type Headaches, Multiple Sclerosis, Parkinson Disease, and Tinnitus J Orthomolecular Med 2012;Vol27(2)

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| label4 = Article | data4 = Intravenous glutathione therapy: Application in ASD and Parkinson's disease, IHP, Dec/Jan 2009

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Article Coenzyme Q10 in Parkinson’s Disease: Ready for First Line Use?, 2010 November Natural Medicine [2]
Traditional Chinese Medicine & Acupuncture recognizes the different disease patterns in Parkinson's and the following strategies are commonly employed based on individual presentation:
  • Tonify Qi, nourish Blood, invigorate the Connecting channels, and extinguish Wind
  • Resolve Phlegm, clear Heat, extinguish Wind and invigorate the Connecting channels [13]
  • Aquatic physiotherapy - physiotherapy can improve postural stability in PD patients, and studies have demonstrated increased efficacy when physiotherapy is performed in water when compared to dry land. [14]
  • Physical medicine is an important aspect of PD treatment to maintain and improve movement and ability to complete activities of daily living. Physical therapies useful in PD treatment include:
  • Tai Chi- studies have demonstrated the use of Tai Chi in PD patients can improve ability to generate momentum and initiate movement. [15]
  • Locomotor training- recent strategies utilizing robot assisted movement as rehabilitation for PD have shown benefits in some PD patient populations. [16]
  • Exercise- the benefits of exercise on quality of life in chronic disease is well established. Interestingly a study investigating the effects of boxing training in PD patients showed beneficial short and long term effects on quality of life, activities of daily living, balance, and gait. [17]

References

Reviewed by Iva Lloyd, BScH, RPE, ND [3]

  1. 1.0 1.1 1.2 1.3 1.4 Prousky, Jonathan (2008) Principles and Practices of Naturopathic Clinical Nutrition. CCNM Press Inc.
  2. 2.0 2.1 2.2 2.3 2.4 Rakel D. (2007) Integrative Medicine 2nd ed. Saunders.
  3. 3.0 3.1 Iranzo A (Nov 2011) Sleep-wake changes in the premotor stage of Parkinson disease. J Neurol Sci.;310(1-2):283-5. PMID: 21880334.
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 Pizzorno Joseph E, Murray Michael T. (2006) Textbook of Natural Medicine 3rd ed, Elsevier
  5. Zheng KS, Dorfman BJ, Christos PJ, Khadem NR, Henchcliffe C, Piboolnurak P, Nirenberg MJ (May 2012) Clinical characteristics of exacerbations in Parkinson disease. Neurologist.;18(3):120-4. PMID: 22549349.
  6. Wirdefeldt K et al. (2004) No evidence of heritability of Parkinson disease in Swedish twins. Neurology;63:305-311
  7. Schlesinger I, Schlesinger N. (Sept 2008) Uric acid in Parkinson's disease. Movement Disorder;23(12):1653-7. PMID: 18618666
  8. Ahlskog JE (Jul 2011) Does vigorous exercise have a neuroprotective effect in Parkinson disease? Neurology.;77(3):288-94. PMID: 21768599.
  9. Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, Maddalozzo G, Batya SS (Feb 2012) Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med.;366(6):511-9. PMID: 22316445.
  10. Ayán C, Cancela J (Apr 2012) Feasibility of two different water based exercise training programs in patients with Parkinson's disease: A pilot study. Arch Phys Med Rehabil. PMID: 22497803.
  11. Silverman EP. (Jan 2006) Tutorial on maximum inspiratory and expiratory mouth pressures in individuals with idiopathic Parkinson disease (IPD) and the preliminary results of an expiratory muscle strength training program. Neurorehabilitation;(21)1:71-9
  12. Hoffman D (2003). Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press
  13. Maciocia G (1994). The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. Churchill Livingstone
  14. Vivas J et al. (2011) Aquatic therapy versus conventional land-based Parkinson's disease: an open-label pilot study. Arch Phys Med Rehabil;Aug(92)8:1202-10
  15. Kim HD et al. (2011) Effects of Tai Chi based exercise on dynamic postural control of Parkinson's disease patients while initiating gait. J Phys Ther Sci Apr;(23)2:265-9
  16. Tefertiller C et al. (Jan 2011) Efficacy of rehabilitation robotics for walking training in neurological disorders: A review. J Rehab Res and Dev;(48)4:387-416
  17. Combs SA et al. (Jan 2011) Boxing training for patients with Parkinson disease: A case series. Phys Ther;(91)1:132-42