Effects Of Interventions : Hm Plus Active Drug Versus Placebo Plus Active Drug
12 studies compared the effect of HM plus active drug and those of placebo plus active drug , , , , , , , , , , , . In 8 studies, global improvement of symptoms was compared between HMs and placebo controls both of which were combined with active drugs , , , , , , , . Among them, significant improvement was observed in 5 studies: Jiaweidadingfeng zhu plus madopar , Naokangning capsule plus madopar , Nuzhenyangyin granule plus madopar and artane , Pabing formula 3 plus madopar and Xifengdingzhan wan plus madopar .
Total UPDRS score was evaluated in 5 studies , , , , and 2 HMs showed significant improvement comparing with placebo plus active drug treatment: Naokangning capsule plus madopar and Xifengdingzhan wan plus madopar .
SF-36 questionnaires were assessed for evaluating quality of life for PD patients in 1 study . Compared with placebo plus active treatment, Naokangning capsule plus madopar improved significantly in the subsections for the physical functioning in Naokangning plus madopar group, 46.83 in placebo plus madopar, P< 0.05), social functioning , 64.63 , P< 0.05), role limitations due to physical health , 49.62 , P< 0.05) and vitality , 48.92 , P< 0.05) .
What Should I Expect At An Appointment
Herbal medicine is not regulated in many countries. It is therefore a good idea to ask your doctor or other healthcare professional for recommendations. Friends, family, other people with Parkinsons or your national Parkinsons association may also be able to advise based on personal experience.
It is advisable to see a therapist who has experience of Parkinsons so do ask about their experience of the condition as well as their qualifications.
The first consultation with a herbal therapist will probably last at least an hour, during which he or she will ask detailed questions about general health, medical and family history, lifestyle and emotional state.
As the approach is holistic, treatment often includes advice on diet and lifestyle as well as herbal remedies. The medicines prescribed may well be made up of a variety of herbs, and will be tailored to individual needs. They can come in a wide range of formulations, including syrups, tinctures, lotions, creams, tablets, inhalations, gargles and washes.
The herbalist may make a follow-up appointment after two weeks, and then monthly, to monitor progress, but this depends on the condition being treated and the individuals general state of health.
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Abnormal Mitochondrial Function And Oxidative Stress
Accumulating evidence suggests that in PD, the function of mitochondrial complex I partially decreases. Approximately 100% of molecular oxygen is consumed by the mitochondria during cellular respiration, and powerful oxidants, including hydrogen peroxide and superoxide radicals, are produced as a by-product. Reactive oxygen species production increases by inhibiting mitochondrial complex I, which can produce toxic hydroxyl radicals or react with nitric oxide and produce peroxynitrites. These molecules can damage the nucleic acids, proteins and lipids by reacting with nucleic acids. One of these injuries can occur in the electron transport chain, which can lead to mitochondrial damage and the formation of ROS that, in turn, can increase the inappropriate folding of proteins .
Factors that contribute to oxidative stress and ultimately neuronal cell death in PD.
The most important approach to treat this disease is the use of precursors and other analogues of dopamine. There is a limitation in prescribing levodopa. Its chronic use is frequently associated with long-term motor impairment and decreased efficacy, requiring the increased dose of levodopa to reduce the complications of the disease. The function of levodopa depends on its enzymatic conversion to dopamine. Therefore, levodopa is usually prescribed in combination with carbidopa to be converted to dopamine by the DOPA decarboxylase .
Bioactive Molecules Derived From Parasitic Plants And Fungi
Cistanche salsa is a parasitic plant used as a Chinese traditional medicine containing acteoside, echinacoside, and tubuloside as its major phenylethanoid glycosides . C. salsa extracts containing these bioactive molecules have been shown to restore behavioral deficit and dopamine depletion in strata of MPTP induced C57 mice . They has also been demonstrated to protect dopaminergic neurons in the substantia nigra of PD model mice, which correlated with neurobehavior improvements and TH positive neuronal levels .
Gastrodia elata blume is a saprophytic perennial herb used traditionally as a medicine due to its wide range of therapeutic benefits. Protective effects of GE extract against MPP+-induced cytotoxicity in human dopaminergic SHSY-5Y cells demonstrated that GE extract dose dependently improved cell viability maintenance, attenuated oxidative damage, modulated expression of Bcl-2 and Bax, caspase-3, and limited poly polymerase proteolysis . Recently, MPP+ induced MN9D dopaminergic cells were shown to exhibit antiapoptotic effects following GE extract treatment. The v anillyl alcohol present in GE was considered to act by attenuating the MPP+ induced elevation of ROS levels and decreasing the Bax/Bcl-2 ratio and poly polymerase .
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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 or standardized mean differences with 95% confidence intervals , while dichotomous outcomes were summarized using risk ratio with 95% confidence intervals . Heterogeneity among studies was detected by I2 and Chi2 tests. If substantial statistical heterogeneity existed , a random-effects model was used. If there was no observed heterogeneity , 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.
Assessing The Quality Of Studies
The methodological quality of all included studies was detailed in the Figure 2. All included studies were randomized studies with explicit description. Specifically, seven studies used random number tables. Four studies used computer-generated lists of random numbers. Two studies employed online center distribution, while only one study stated the method for sequence generation by simple randomization. Eleven studies reported adequate allocation concealment. Four adopted opaque and sealed envelopes. The remaining studies adopted center distribution. Of 14 included studies, 8 studies applied double blinding and 6 studies had triple blinding. All studies had low risk of bias in the incomplete out-come data. Four studies had unclear risk of bias in selective reporting because of no available protocols. Other risks of bias were described in one study , which reported significant differences in baseline values of some outcome variables.
Figure 2. Risk of bias of the included studies. Risk of bias summary: judgements about each risk of bias item for each included study. 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.
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Neuroprotective Effects Of Ornamental Plants
Paeoniae lactiflora is an ornamental flowering plant known for its dried root. Paeoniflorin , a monoterpene glucoside, is abioactive molecule produced by Paeoniae alba Radix and is reported to have a neuroprotective effect on dopaminergic neurons in an MPTP mouse model for PD. Dose dependent subcutaneous administration of PF restored TH positive cells, dopaminergic neuronal paucity, and ameliorated bradykinesia. The mechanism of action is due to PF acting as an agonist for the adenosine A1 receptor, which down regulates microglial and astrocytic activation and neuroinflammation .
Dendrobium nobile Lindl. is an ornamental medicinal plant in the Orchidacea family, which is rich in the bioactive benzyl compound chrysotoxine .
Chrysotoxine is reported to protect SHSY-5Y cells against 6-OHDA toxicity through mitochondrial protection and NF-B modulation. Chrysotoxine pretreatment exerts beneficial effects including attenuation of 6-OHDA- induced intracellular generation of ROS, and activation of p38 MAPK and ERK1/2. Mitochondrial dysfunction is reverted through multiple mechanisms including the decrease of membrane potential, increase of intracellular free Ca2+, release of cytochrome c, imbalance of Bax/Bcl- 2 ratio and decrease in activation of caspase-3. An anti- inflammatory for response is exerted by suppression of NF- B activation by blocking its translocation to the nucleus, thereby preventing up-regulation of iNOS and intracellular NO release .
Fruit Vegetable And Spice Derived Nutraceuticals For Pd
Levodopa was first isolated from the seeds of the leguminous plant Mucuna pruriens, which is native to India and other parts of the tropics including Central and South America and Mucuna spp are considered to be richest natural sources of L-DOPA hotels of the world bay of many coves resort, luxury logdes of new zealand . . The administration of 30 grams of Mucuna seed powder has been reported to have antiparkinsonian effects in PD patients, with a more rapid onset of action, shorter latency, and enhanced improvement compared to the standard combination of levodopa and carbidopa treatments . Vicia faba is an edible bean found in the Mediterranean region and is rich in L-DOPA . The ingestion of broad beans in PD patients has been shown to elevate L-DOPA plasma levels which have correlated with cognitive improvement in the same magnitude as levodopa/carbidopa administration . Another study suggested that 2,4- epibrassinolide , a natural Brassinosteroid found in V. faba, offers antioxidative and antiapoptotic effect on MPTP induced PC12 cells. The mechanism underpinning the effect was considered to be due to modulation of antioxidant enzymes, Bax/Bcl-2 protein ratio, and cleaved caspase-3.
Lycopersicon esculentum L. is rich in lycopene and well-known for its edible fruit. Pretreatment with a diet containing lyophilized tomato powder correlated with a decreased DA loss in a MPTP- induced PD model .
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Summary Of The Literature Cited
There are over 140 studies published in the last 10 years associated with the beneficial effects of plant- derived natural products and PD. This review included electronic searches of the PubMed, Medline, Scopus, EMBASE, CINAHL, AMED, PsycInfo, CNKI, 7 Korean Medical Databases, J-East and Web of Science with the search terms as follows: Parkinsons disease therapy, natural products parkinsons disease, phytochemicals, antioxidants and plant extracts in various combinations. The Dopamine and PD section is provided since the etiology of PD is thought to be due to an imbalance in brain dopamine levels. This review presents a summary of literature on the relationship between dopamine levels and motor function in PD, and the beneficial effects of natural products which demonstrate potential anti-PD properties. This also review summarizes recent progress in determining the potential mechanism of action on PD.
Search Strategy And Selection Criteria
The focus of our paper were plants used for the treatment of PD, and only plants tested in humans. As noted previously, plants with mechanisms of action beyond simply demonstrating antioxidant activities were selected.
The methodology for systematic reviews was modified and divided into a two stage process owing to the availability of references and the languages in which they are written. For the European plants, due to the lack of systematic databases on herbs traditionally used to treat PD, the first stage focused on hard-cover books published in Croatia and surrounding countries to prepare the list of herbs used in Europe, and the oldest book used was Gursky . For herbs used in Asia, the same strategy was used, although the unavailability of books published in English was a challenge. Most of the books which were referred for this review were published in either Sinhala or Tamil, which are two native languages of Sri Lanka. Nevertheless, in order to avoid translational errors and misinterpretations, occasional referencing of Sinhala and Tamil books for verification purposes was carried out while primary sourcing was done in books published in English.
Table 1. Bioactive compounds with neuroprotective effects isolated from European and Asian plants.
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Lessons From Blackfeet Nation
The Purdue researchers interviewed healers and locals on the Blackfeet Indian reservation located in Western Montana. They asked what plants the healers used when someone reported with any of the symptoms mentioned above.
They proceeded to test those plants that were used in the laboratory. The healers indicated 19 different medicinal plants used to treat some of the symptoms that also present in Parkinsons.
Out of these 19 medicinal plants, the researchers tested 10 as extracts. In particular, they tested the plants ability to stimulate what is called the nuclear factor/E2-related factor 2 or more simply, Nrf2.
The Nrf2 activation is a natural process that helps prevent the malfunctioning of tiny cell organelles called mitochondria. This essentially makes Nrf2 able to protect the neurons that produce dopamine within the brains substantia nigra.
So the researchers tested whether any of the herbal medicines used by the Blackfeet were able to activate the Nrf2 factor in neuron cells.
To test the herbs ability to protect neurons, the researchers utilized the toxins paraquat and rotenone. These are two modern chemicals that have been linked to Parkinsons and substantia nigra dopamine-producing neuron damage.
To their surprise, seven of the 10 plant extracts stimulated the Nrf2 activity among brain cells in the presence of these toxins. In particular, three healer-recommended plant extracts stimulated Nrf2 in the presence of rotenone, thereby protecting the brain cells:
A Contemporary Understanding And Existing Therapeutic Gaps
Parkinson’s disease is a complex multi-system, neurodegenerative disease. Though predominantly perceived as a motor disease, it also has debilitating non- motor features, which are frequently missed and not treated. Major treatment goals are to increase striatal dopamine levels with precursor-substitution and/or reduce its breakdown. As the disease progresses, a steady increase in the dose of levodopa is inevitable. However, higher doses cause motor complications of dyskinesia and dystonia and compromise medical treatment.
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Parkinsons Foundation Centers Of Excellence And Medicinal Marijuana
The Parkinsons Foundation, in partnership with Northwestern University researchers, studied attitudes about cannabis at 40 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 concerning 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 Parkinsons Foundation centers as 95 percent of neurologists reported patients have asked them to prescribe it.
Cannabis study results also included:
- Only 23 percent of physicians had any formal education on the subject of cannabis , thus 93 percent of physicians want cannabis taught in medical school.
- Physicians reported that 80 percent of their patients with PD have used cannabis.
- Only 10 percent of physicians have recommended the use of cannabis to patients with PD.
- In terms of memory: 75 percent of physicians felt that cannabis would have negative effects on short-term memory and 55 percent felt that cannabis could have negative effects on long-term memory
- Only 11 percent of physicians have recommended use of cannabis in the last year
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.
Importance Of Vitamins Minerals And Other Supplements In The Treatment Of Parkinson
Among the main natural remedies that can help treat Parkinsons disease we can include the following:
- Vitamin B6 : The use of this vitamin stimulates the production of dopamine. The usual dose is around 150 mg daily in three divided doses. This vitamin interferes with other drugs commonly prescribed to treat the disease. Consult your doctor before starting treatment.
- Vitamin E: It constitutes a powerful antioxidant that can help protect the cells of the brain. The habitual dose is stipulated in 400 daily UI.
- Vitamin C: Like vitamin B, its antioxidant activity helps to protect the brain cells, including those ones in charge of the dopamine production. Usual treatment intake is about 2000 daily mgs, distributed in two takings.
- NADH: , NADH is a coenzyme present in all cells. Involved in cellular energy production and is necessary for cells to function properly. Thus, for its antioxidant properties, it is thought to help reduce free radicals.Because of its importance as a neurotransmitter, enhances memory, logic and thought. NADH supplements have been used to treat neuronal degenerative diseases such as Parkinsons or Alzheimers. The usual dose is 5 mg daily before breakfast.
- Coenzyme Q10: It is believed that the use of this coenzyme can help slow the progression of the symptoms of this disease. The usual dose is usually about 150 mg daily divided into three portions at meals.
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Description Of The Hm Formulas
Fourteen studies reported a wide range of TCM formulas, including Bushen Huoxue granule , Zengxiao Anshen Zhichan 2 capsule , Zengxiao Anshen Zhichan 2 granule , Zhichan decoction , Zhichan granule , Guilu Dihuang capsule , Jiawei Liujunzi Tang granule , Yangxue Qingnao granule , Congwu Qufeng granule , Yishen Chuchan decoction , Naokang granule , Guiling Pa’an capsule , and Guiling Pa’an granule . The ingredients of TCM formulas in each included studies were presented in Table 2. A total of 52 herbs were used in these TCM formulas. High-frequency herbs in HM formulas were ranked in Table 3. The top 11 most frequently used herbs were 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 .
Table 2. Ingredients of TCM formula.
Table 3. The 11 high-frequency used herbs for PD in the 14 trials included.