Complementary and Alternative Therapy in Parkinson's Disease

Parkinson’s disease (PD) is characterized by progressive loss of dopaminergic nigro-strial neurons resulting in the characteristic symptoms of PD. As it is a progressive disorder with no cure, no drugs are available which can prevent the occurrence of PD or slow its progress. 1 This creates a lacuna in the armamentarium of therapy of PD. Since the 1960’s, after the discovery of levodopa, other drugs discovered so far only provide a replacement to deficient dopamine. Dopamine replacement therapy (DRT) with levodopa is still the best symptomatic therapy and is known to extend life expectancy. 2 Over the years of use of levodopa, the therapeutic efficacy of levodopa wanes, both in terms of benefit in motor symptoms and in duration of effect. A large number of patients experience disabling side effects in the form of sleep attacks and psychosis, with incomplete relief of symptoms. 3–6 A large number experience levodopa induced motor fluctuations as the disease advances. This necessitates modification of the dosage, change in the formulation of levodopa, and combine it with DA agonists or other drugs to control the adverse symptoms. Complementary and Alternative Medicine (CAM) is sought when pharmacotherapy fails to meet the requirements of PD patients. However, a small percent use CAM even in the early stage of illness when there are no problems with pharmacotherapy or as the sole therapy. Complementary and alternative medicine (CAM) are a group of management practices which are not part of western medicine. 7 The term “complementary” is used when these management practices are used along with conventional medicines. 8 On the other hand the term “alternative” is used as they are solely used in the absence of conventional medicines. CAM’s use varies from 40–76%. 9 , 10 Though, CAM has been used by PD patients in all parts of the world, it is rather traditional in some parts of countries like China, India, Korea and the Amazon-region, where the use of traditional medicines are very strong. It varies from preparations of herbs containing anticholinergic agents, levodopa and MAO-B inhibitors. Different forms of CAM which are generally used, consist of oral ingestion or application of these preparations on skin surface as ointments or pastes. They also include practices such as yoga, meditation, dance, music, exercise etc. Many patients describe reasons for using CAM for the “feel good factor”, belief that it is free from side effect, or as a replacement of western medicines, as these are considered to have side effects. 10 Commonly used CAMs include Ayurvedic medicines, homeopathic medicines and acupuncture.