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Parkinson’s Disease Treatment

Parkinson’s disease, or PD, is a progressive neurologic movement disorder. It affects the nervous system which is responsible for movement. With a gradual onset it is hardly noticeable early on. Symptoms of a tremor are typically found in one hand, are slight, and commonly attributed to “nerves” but without recognition of the significance of the actual disease. It is only when the tremor worsens or patients begin to suffer with a “stiffness”, shuffling gait or slowing of movement that patients or family members begin to suspect PD.

With Parkinson’s disease your symptoms typically advance slowly. The symptoms are also varied from patient to patient. These symptoms can include flat expressions, muffled voice, difficulty walking, shuffling gait, or not swinging the arms. The patients may have postural issues that result in kyphosis (a forward bend of the upper body) that results in pain or even a tendency to feel as though one is falling forward. In advanced PD it is not uncommon to have patients who shuffle forward and ultimately lose control and fall forward.

At present there is no known “cure” for PD. There are medications prescribed by neurologists that attempt to help with symptoms. There is also the possibility of surgical intervention. The use of Functional Medicine techniques has grown in recent years as funding for research has increased. While Parkinson’s disease can’t be “cured”, certain treatments can markedly improve symptoms. Stem Cells are at the forefront of PD therapy as an option to facilitate improvement in the condition of patients. Additionally, the use of antioxidants, namely glutathione, has become increasingly popular. Addressing immune dysregulation with the use of phototherapy to help down regulate inflammation is another form of treatment.

Parkinson’s symptoms can include:

  • Tremors or shaking. This usually begins in a limb, often your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor.
  • Slowed movement (bradykinesia). PD will slow your movement, making simple tasks difficult, time-consuming and even dangerous due to balance issues and tendencies to trip.
  • Rigid muscles. Muscle stiffness causes limits in your range of motion and results in pain.
  • Impaired posture and balance. PD can cause impaired posture, a stooped over position and balance problems.
  • Loss of automatic movements. Diminished ability to perform unconscious movements such as blinking, smiling or swinging your arms when you walk.
  • Speech changes. Speech impairment causing one to speak softly, quickly, slur, hesitate or become monotone.
  • Writing changes. Fine motor impairment affecting writing.

When to see a doctor

See your doctor to diagnose your condition and rule out other causes.

Causes

In Parkinson’s disease, nerve cells gradually break down or die as a result of oxidative stress. Many symptoms result from a loss of neurons in the brain that produce dopamine, a chemical messenger that is involved with regulating movement. When dopamine levels become inadequate, brain activity becomes abnormal leading to signs of Parkinson’s disease through impaired or inappropriate movement.

While the exact cause of Parkinson’s disease is unclear, several factors are implicated:

  • Specific genetic mutations can cause PD, but these are uncommon.

However, certain variations can increase the risk of PD.

  • Environmental triggers. Certain toxins or environmental factors may increase the risk of later Parkinson’s disease, this is especially concerning when considering EpiGenetics or the personalized expression of a disease based on exposure to a chemical or toxin in light of a personal genetic tendency.
  • Lewy bodies.Specific substances within brain cells that are markers of PD.
  • Alpha-synuclein. protein found in Lewy bodies which cells can’t break down.

Risks

Risk factors for PD include:

  • It ordinarily begins in middle or late life, with risk increasing with age. People typically develop the disease at or around age 60 or older.
  • Close relatives with Parkinson’s disease increases the odds that you’ll develop the disease.
  • Men are more apt to develop Parkinson’s disease than women.
  • Exposure to toxins.Exposure to herbicides and pesticides increase the risk of Parkinson’s disease.

Complications

Parkinson’s disease can be associated with these additional problems:

Thinking difficulties. Occurs in later stages of PD and cognitive aren’t very responsive to medications.

  • Depression and emotional changes.People with Parkinson’s disease may experience depression, anxiety, amotivational syndrome. .
  • Swallowing problems. Difficulty swallowing can occur with worsening of condition.
  • Sleep problems and sleep disorders.Sleep dysregulation with inverted circadian rhythm. Sleep disturbance can include vivid dreams with associated “acting out”
  • Bladder problems.As a neuromuscular disease PD can effect bladder emptying.
  • The neuromuscular effects can extend to the GI tract with impaired gastric emptying resulting in constipation.

You may also experience:

  • Blood pressure changes. Low blood pressure with standing causing you to feel dizzy or lightheaded
  • Smell dysfunction.Difficulty distinguishing smells.
  • Loss of energy of unclear origin, potentially inflammatory or immune.
  • Many people with Parkinson’s disease experience specific pain, generalized pain or both.
  • Sexual dysfunction.ED is a common side effect for patients with PD.

Testing and Diagnosis

There is no specific lab or imaging test to make the diagnosis. The symptoms and exam are highly suggestive. If the symptoms improve with therapy for PD the diagnosis is even more likely.

Tests may be ordered to “rule out” other conditions. These tests include blood tests like CBC, Chemistries and imaging such as MRI, US, SPECT and PET scans.

Treatment

Treatment is highly personalized. As PD effects everyone differently and there is no single way to treat, it is imperative to construct a treatment plan tailored to the individual. The treatment programs are comprehensive engaging the patient in the way of the lifestyle, diet, exercise, ultimately functional therapies including antioxidants, vitamin infusions and antioxidative therapies are leveraged to improve immune function, provide enhanced metabolism substrates and ultimately restore quality of life.

Medications

Certain medications can help manage issues with walking, irregular movement or tremors. These medications serve to help increase or act as a substitute for dopamine which is a neurotransmitter or “signaling chemical” in your brain.

Dopamine concentrations have been found to be low in patients with PD. However, since dopamine doesn’t cross the blood brain barrier it is unclear how, exactly, dopamine when given directly, helps to improve symptoms attributable to low dopamine levels.

Commonly prescribed medications include:

  • Carbidopa-levodopa.a chemical that passes into your brain and is converted to dopamine.

Initially effective, the patient can develop side effects may including nausea or lightheadedness (orthostatic hypotension). Additionally, over time the benefits can lessen with an “on/off” phenomenon.

  • Carbidopa-levodopa infusion.The infusion allows for a steady state level of dopamine with the intent being to stabilize the symptoms. The risks and invasive nature limit this to patients who are otherwise failing traditional therapy.
  • Dopamine agonists. Dopamine agonists mimic dopamine effects in your brain by binding to dopamine receptors.

While not as effective as levodopa, the half-life is longer which helps to reduce the on/off phenomena.

Side effects include: hallucinations, sleepiness and compulsive behaviors such as hypersexuality, gambling and binge eating.

  • MAO-B inhibitors. Prevent the breakdown of dopamine by inhibiting monoamine oxidase B (MAO-B) which metabolizes dopamine. Side effects may include nausea or insomnia.
  • Catechol-O-methyltransferase (COMT) inhibitors.Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.

Side effects, including an increased risk of involuntary movements (dyskinesias), mainly result from an enhanced levodopa effect. Other side effects include diarrhea or other enhanced levodopa side effects.

Tolcapone (Tasmar) is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.

  • These medications were used for many years to help control the tremor associated with Parkinson’s disease. Several anticholinergic medications are available, including benztropine (Cogentin) or trihexyphenidyl.

However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.

  • Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson’s disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson’s disease to control involuntary movements (dyskinesias) induced by carbidopa-levodopa.

Side effects may include a purple mottling of the skin, ankle swelling or hallucinations.

Surgical Procedures

  • Deep brain stimulation.In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce your Parkinson’s disease symptoms.

Your doctor may adjust your settings as necessary to treat your condition. Surgery involves risks, including infections, stroke or brain hemorrhage. Some people experience problems with the DBS system or have complications due to stimulation, and your doctor may need to adjust or replace some parts of the system.

Deep brain stimulation is most often offered to people with advanced Parkinson’s disease who have unstable medication (levodopa) responses. DBS can stabilize medication fluctuations, reduce or halt involuntary movements (dyskinesias), reduce tremor, reduce rigidity, and improve slowing of movement.

DBS is effective in controlling erratic and fluctuating responses to levodopa or for controlling dyskinesias that don’t improve with medication adjustments.

However, DBS isn’t helpful for problems that don’t respond to levodopa therapy apart from tremor. A tremor may be controlled by DBS even if the tremor isn’t very responsive to levodopa.

Although DBS may provide sustained benefit for Parkinson’s symptoms, it doesn’t keep Parkinson’s disease from progressing.

If you’ve received a diagnosis of Parkinson’s disease, you’ll need to work closely with your doctor to find a treatment plan that offers you the greatest relief from symptoms with the fewest side effects. Certain lifestyle changes may also help make living with Parkinson’s disease easier.

Healthy Eating

While there’s no food or combination of foods proven to help in Parkinson’s disease, some foods may help ease some of the symptoms. For example, eating foods high in fiber and drinking an adequate amount of fluids can help prevent constipation that is common in Parkinson’s disease.

A balanced diet also provides nutrients, such as omega-3 fatty acids, that may be beneficial for people with Parkinson’s disease.

Exercise

Exercising may increase your muscle strength, flexibility and balance. Exercise can also improve your well-being and reduce depression or anxiety.

Your doctor may suggest you work with a physical therapist to learn an exercise program that works for you. You may also try exercises such as walking, swimming, gardening, dancing, water aerobics or stretching.

Parkinson’s disease can disturb your sense of balance, making it difficult to walk with a normal gait. Exercise may improve your balance. These suggestions may also help:

  • Try not to move too quickly.
  • Aim for your heel to strike the floor first when you’re walking.
  • If you notice yourself shuffling, stop and check your posture. It’s best to stand up straight.
  • Look in front of you, not directly down, while walking.

Avoiding Falls

In the later stages of the disease, you may fall more easily. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help:

  • Make a U-turn instead of pivoting your body over your feet.
  • Distribute your weight evenly between both feet, and don’t lean.
  • Avoid carrying things while you walk.
  • Avoid walking backward.

Daily Living Activities

Daily living activities — such as dressing, eating, bathing and writing — can be difficult for people with Parkinson’s disease. An occupational therapist can show you techniques that make daily life easier.

Some types of alternative medicine may help people with Parkinson’s disease, including:

  • Coenzyme Q10.Early research suggested that high doses of coenzyme Q10 — a readily available supplement — may be beneficial for people in the early stages of Parkinson’s disease. However, the benefits appear to depend on taking the supplement for 16 months or longer.
  • Massage therapy can reduce muscle tension and promote relaxation. These services, however, are rarely covered by health insurance.
  • During an acupuncture session, a trained practitioner inserts tiny needles into many specific points on your body, which may reduce your pain.
  • Tai chi.An ancient form of Chinese exercise, tai chi employs slow, flowing motions that may improve flexibility, balance and muscle strength. Tai chi may also prevent falls. Several forms of tai chi are tailored for people of any age or physical condition.

A study showed tai chi may improve the balance of people with mild to moderate Parkinson’s disease more than stretching and resistance training.

  • In yoga, gentle stretching movements and poses may increase your flexibility and balance. You may modify most poses to fit your physical abilities.
  • Alexander technique.This technique — which focuses on muscle posture, balance and thinking about how you use muscles — may reduce muscle tension and pain.
  • In meditation, you quietly reflect and focus your mind on an idea or image. Meditation may reduce stress and pain and improve your sense of well-being.
  • Music or art therapy.Music or art therapy may help you to relax. Music therapy helps some people with Parkinson’s disease to improve their walking and speech. Participating in art therapy, such as painting or ceramics, may improve your mood and help you relax.
  • Pet therapy.Having a dog or cat may increase your flexibility and movement and improve your emotional health.

Our understanding of Parkinson’s disease has evolved from one in which the motor symptoms were the primary focus of treatment to one where the broader effects of the disease process are more likely to be acknowledged and treated, as well.  People with PD who are seeking relief from their symptoms may decide to explore complementary therapies, which can support or complement Western or traditional medicine. While there are many kinds of complementary medicine that might be of interest to someone living with PD, this section focuses on herbs, vitamins and supplements.

If you are considering complementary medicine, we strongly urge you to investigate the credentials and experience of anyone offering advice or product recommendations regarding such products.

Key Points

  • Most herbs and supplements have not been rigorously studied as safe and effective treatments for Parkinson’s disease.
  • The FDA does not strictly regulate herbs and supplements.
  • There is no guarantee of safety, strength or purity of supplements not monitored by the FDA.

With those facts in mind, learn more about some complementary medicines:

Vitamin C/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” or scavenge 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; this may result from the form of Vitamin E commonly available, alpha-tocopherol. A “mixed” supplement, containing multiple forms of Vitamin E, may turn out to be safer or more effective.
  • More research is needed; meanwhile 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, a moderately potent antioxidant was studied in people with early PD in a large study in the 1980s.
  • The study  of Vitamin E did not demonstrate a slowing effect or neuroprotection, and in fact, showed that it could potentially be harmful to PD patients.  Researchers believe that more studies are required.
  • However, it is possible that dietary Vitamin E may be used more easily by the body than the supplements used in the study.

The Mediterranean Diet

THE MEDITERRANEAN DIET

  • This might be another reason to consider the Mediterranean diet.
  • There is some evidence that the so-called 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.
  • Persons with PD are often particularly concerned about the possibility that protein intake can decrease the effectiveness of carbidopa/levodopa, one of the common medications used to treat PD.
  • Levodopa absorption in the brain can be slowed by a high protein meal, and  as the disease progresses, most patients find that their symptoms are better controlled if they have most of their protein later in the day.
  • Since PD can affect digestive function, many patients do notice symptoms such as constipation and early satiety (the sensation of feeling very full after consuming a small amount of food).

Summary

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

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

  • Calcium-fortified orange juice
  • Calcium-fortified-rice and soy milk alternatives for use on cereal, smoothies, and in many cooked dishes.
  • Breakfast cereals and other foods fortified with calcium.
  • You might also consider taking a calcium supplement—calcium citrate is often a better choice.
  • Chewable calcium tablets are better absorbed, because they are already broken down when they reach the stomach.

The current recommendation for vitamin D is 400 IUs for people age fifty or older; and 600 IUs daily for those over the age of 70.

Vitamin D

natural source of Vitamin D

  • Without adequate amounts of vitamin D calcium can’t be absorbed by the body.
  • If you live in a sunny area, vitamin D is easy to get through about one hour per week outdoors in the sunshine with the face, hands, and arms exposed.
  • Because vitamin D is stored, our bodies can conserve enough D during the summer to last us through the winter.

If you do not live in a sunny area or you mostly stay indoors here’s what you can do by tapping into foods rich in vitamin D to get the amount you need:

Food Sources of Vitamin D

  • Fortified foods such as milk and milk substitutes, milk products, margarine and cereals.
  • Fatty fish, such as salmon and fish liver oils.
  • Liver
  • Eggs

Co Q10

  • Cells need energy to survive and function.
  • They contain mitochondria, which are “batteries” that produce energy.
  • In Parkinson’s disease, there seems to be a disturbance in the function of these batteries.
  • Coenzyme Q10 seems to affect this energy-generating mechanism in cells, although the exact mechanism remains a mystery.
  • A trial sponsored by NIH and the Parkinson Study Group was ternimated in May 2011 because it showed no neuroprotective benefit or symptomatic benefit of Coenzyme Q10 for people with early Parkinson’s disease. However, this negative finding may help scientists to close in on several possible mechanisms and to focus on a set of more promising drugs and studies.
  • Findings of this study are specific to PD and they do not reflect the possible value Coenzyme Q10 may have in other disorders.

GINKO BILOBA

Gingko research in the U.S. has been limited to stroke recovery and Alzheimer’s disease, but Dr. James A. Duke, author of The Green Pharmacy, suggests that it might be helpful in PD because it improves blood circulation through the brain, possibly delivering more levodopa. While Dr. Duke suggests that significantly higher doses might be useful in people with PD, doses higher than 240 mg per day may cause diarrhea. Ginkgo also has some “alerting” properties and therefore may be helpful in combating daytime sleepiness—a common side effect of levodopa/carbidopa.

Caution:

  • Gingko may raise blood pressure when taken with a thiazide diuretic such as hydrochlorothiazide.
  • Caution should be used when taking Gingko with PD medications as some may have harmful interactions.
  • In addition, it tends to have an anti-clotting effect. Therefore, if you are taking any other anti-clotting medication such as aspirin or warfarin (Coumadin), you should not take Ginkgo without consulting your health care provider.
  • Do not confuse gingko biloba with ginseng, as ginseng may be overstimulating in older adults.
  • Folate (Vitamin B9) is another vitamin that is important for brain health and good memory.
  • It is 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 may help memory as well.
  • GTPs have antioxidant and free radical scavenging activities.
  • There have been some studies suggesting 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 in Sunnyvale, CA (NPF Center of Excellence) are currently studying whether GTPs can slow the progression of PD in a large, placebo-controlled study.

With medical marijuana now legalized in 25 states and Washington, D.C., it is obvious that there is strong interest in its therapeutic properties. Researchers are testing marijuana, which they call cannabis, as a treatment for many illnesses and diseases, including neurological conditions, with Parkinson’s disease (PD) high on the list. But despite several clinical studies, it has not been demonstrated that cannabis can directly benefit people with Parkinson’s. What is the science and pharmacology behind marijuana, and can it be used to treat Parkinson’s symptoms?

The Science Behind Marijuana

THE SCIENCE BEHIND MARIJUANA

The endocannabinoid system is located in the brain and within the central and peripheral nervous systems. This system is made up of cannabinoid receptors (a receptor is molecular switch on the outside of a cell that makes something happen inside a cell when activated) that are linked to neurons (brain cells) that regulate thinking and some body functions.

Researchers began to show enthusiasm to study cannabis in relation to Parkinson’s after people with PD gave anecdotal reports and posted on social media as to how cannabis reduced their tremors. Some researchers think that cannabis might be neuroprotective — saving neurons from damage caused by Parkinson’s. Besides reducing tremor, cannaboids (the drug molecules in marijuana) have also been studied for use in treating other symptoms, like bradykinesia (slowness caused by PD) and dyskinesia (excess movement caused by levodopa). Despite some promising preclinical findings, researchers have not found any meaningful cannabis benefits for people with Parkinson’s.

Researchers issue caution for people with PD who use cannabis because of its effect on thinking. Many people with Parkinson’s experience impairment of the executive function — the ability to make plans and limit risky behavior. People with a medical condition that impairs executive function should be cautious about using any medication that can compound this effect.

The Pharmacology of Cannabis

Marijuana contains more than 100 neuroactive chemicals that work with two types of cannabinoid receptors, type 1 (CB1) located in the brain and type 2 (CB2) located in the peripheral immune system. Cannaboids have powerful, indirect effects on these receptors, but researchers are unsure how. People with PD have less CB1 receptors than people who do not have PD. A boost to the CB1 receptor through an agonist, like marijuana, can improve tremors and may alleviate dyskinesia. Similarly, the other receptor, CB2, is also being studied to determine if it can modify the disease or provide neuroprotective benefits. However, a unified hypothesis does not currently exist for either receptor because there is too much conflicting data on the effectiveness of cannaboids and these receptors.

Cannabis can contain two different types of molecules that interact with cannabinoid receptors: agonists and antagonists. An agonist is a drug that attaches to the same receptor as a natural chemical and causes the same effect. A dopamine agonist is a drug that is not dopamine, but attaches to the dopamine receptor. An antagonist is different as it attaches to the receptor, but blocks the action of the natural chemical. Some drugs are dopamine antagonists, which block dopamine and are dangerous for people with PD. Medical marijuana can contain both cannabinoid agonists and antagonists. Recreational marijuana use is derived from its effects on agonists.

The varying amounts of cannabinoid agonists and antagonists in different marijuana plants makes cannabis studies difficult to conduct. When researchers study the effects of a drug, dosages are controlled and often set to a specific number of milligrams. When testing medical marijuana, the dosage administered can vary dramatically depending on the plant and method of administration.

Delta-9-tetrahydrocannibinol (THC)

THC is a type of cannabinoid and the primary component of marijuana. It has a long latency of onset and cannot be easily measured for a therapeutic or medicinal dose. Medical marijuana studies primarily provide participants with THC in the form of a capsule, nasal spray or liquid.

PD-Related Medicinal Marijuana Trials

The use of cannabinoids has been suggested to help with managing neurological and non-neurological conditions. Literature on medicinal marijuana is incredibly varied. Studies have not clearly supported the use of marijuana for Parkinson’s. The clinical studies of cannabis as a PD treatment that have been conducted did not use the clinical trial gold standard of a double blind, placebo controlled trial design. Some studies had as few as five subjects. While some results have been positive, the effects of medical marijuana are probably not completely understood, which is why more studies, especially those that enroll a greater number of subjects, are needed. Most doctors do not support study results because these studies do not meet the minimum research standard.

Below are several PD-related medical marijuana studies that have been conducted to evaluate the use of cannabinoids in Parkinson’s:

Risks and Benefits for People with Parkinson’s

There are risks and benefits associated with the use of cannabis for people with PD. Benefits include a possible improvement in: pain management, sleep dysfunction, weight loss and nausea. Potential adverse effects include: impaired cognition (impairment in executive function), dizziness, blurring of vision, mood and behavioral changes, loss of balance and hallucinations. Chronic use of marijuana can increase risk of mood disorders and lung cancer.

Medical Marijuana and Legislation by State

Washington, D.C., and 28 states passed legislation allowing the use of marijuana-based products for medical purposes. Three of those states (Minnesota, New York and Ohio) do not allow it to be smoked. In some states patients must register in order to possess and use cannabis. Other states require patients to acquire a document from a physician stating that the patient has an approved condition. Under federal law doctors cannot prescribe cannabis, but many states authorize them to issue certifications that allow patients to obtain medical marijuana.

Six states specifically list Parkinson’s as an approved condition for medical marijuana: Connecticut, Illinois, Massachusetts, New Mexico, Ohio and New York. It was legalized for recreational use in Alaska, California, Colorado, Oregon, Washington and Washington, D.C.

Medical marijuana is legal in: Arizona, Arkansas, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Pennsylvania, Rhode Island and Vermont. In Texas, medical marijuana is only approved for people with epilepsy.

NPF Centers of Excellence and Medicinal Marijuana

NPF in partnership with Northwestern University researchers studied attitudes about cannabis at 40 NPF Centers of Excellence. To the best of our knowledge, this is the first study to provide data on the practices, beliefs and attitudes of expert PD physicians in regards to cannabis use.

The results were interesting: most experts said they knew what cannabis did, but disagreed on the details. While there is no general agreement on what the benefits might be for people with PD, the survey confirmed that cannabis is a popular subject within NPF centers as 95 percent of neurologists reported patients have asked them to prescribe it.

Cannabis study results also included:

  • Only 23% of physicians had any formal education on the subject of cannabis (such as a course or lecture), thus 93% of physicians want cannabis to start being taught in medical school.
  • Physicians reported that 80% of their patients with PD have used cannabis.
  • Only 10% of physicians have recommended the use of cannabis to patients with PD.
  • In terms of memory: 75% of physicians felt that cannabis would have negative effects on short-term memory and 55% felt that cannabis could have negative effects on long-term memory
  • Only 11% of physicians have recommended use of cannabis in the last year

Graph caption: This graph shows how physicians expect cannabis would improve, worsen, or show no effect to PD-related symptoms given their expertise and observations of patients with PD.

The study emphasized that physicians would be more apt to the use of medical marijuana as a treatment if the drug was approved through regulation instead of legislation. Nearly all medications are only approved after passing a science-based evaluation proving their effectiveness in a process overseen by the US Food and Drug Administration. Since cannabis has been approved through legislation rather than regulation, there are no label, dosage recommendation or timing instructions that physicians can reference.

Is Medical Marijuana an Option for Me?

What’s next for a person with Parkinson’s who wants to know if medical marijuana is an option? “Marijuana should never be thought of as a replacement for dopaminergic and other approved therapies for Parkinson’s disease,” said Dr. Michael S. Okun, NPF’s National Medical Director. Research is still needed to determine how medical marijuana should be administered and how its long-term usage can effect Parkinson’s disease symptoms. To keep patients safe, states that legalize medical marijuana will eventually need to develop training programs for doctors and medical teams that prescribe medical marijuana. Consult your doctor to see if medical marijuana is an option for you.

  • 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 liver cells that have been damaged.
  • Milk thistle 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.
  • Milk thistle is also 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 not currently any published studies of milk thistle in the treatment of PD.
  • This herbal supplement is a popular anti-depressant, working in a pharmacologic manner similar to the prescription serotonin re-uptake inhibitors (SSRIs).
  • It may be effective in mild to moderate depression but two studies reported no benefit in major depression.
  • In Germany, where it is the most frequently prescribed antidepressant medication, the dose commonly used is 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, which appear to be very 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:

  • John’s Wort may interfere with certain PD medications, most particularly MAO-B inhibitors.
  • 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.
  • John’s Wort should not replace traditional prescription medicine for the treatment of a serious or major depressive episode.
  • Those who take blood thinners such as aspirin, heparin or warfarin (Coumadin) should not take St. John’s Wort.
  • People with PD who also take asthma medications, steroids or birth control pills should consult their physicians or health care providers before taking St. John’s Wort.