Complementary and Alternative Medicine (CAM) Therapies

Key Facts

  • CAM Therapy has not been proven to be beneficial or harmful in most situations.
  • Consider cost and potential adverse effects of each therapy.

Clinical Best Practices

  • You should continue to stress the need for your patients to exercise and to adhere to a medical regimen with proven PD meds (levodopa, dopamine agonists, MAO-B inhibitors, etc), even if they are using complementary and alternative therapies.  

There is very little evidenced-based data to indicate that many of the therapies described below are beneficial (or harmful), and the studies that have been performed are based on largely open-label designs and anecdotal reports. A review by the American Academy of Neurology failed to identify much evidence in support of most complementary and alternative therapies.

 

Highlights of current alternative and complementary therapies:

CoQ10

  • May interfere with warfarin
  • No evidence of effectiveness

Creatine

  • Can lead to weight gain
  • Check renal function in patients taking this supplement

Glutathione

  • Is an antioxidant
  • Appears reduced in PD patients
  • Glutathione infusions are occasionally recommended for PD patients by practitioners, but there is no evidence to support their use in PD as of yet
  • Infusions of this supplement are given intravenously and are very costly

Mucuna Pruriens (“Velvet Bean” or Cowitch Plant)

  • Mucuna pruriens has been used in Indian ayurvedic medicine for the treatment of PD.
  • It contains levodopa (as do fava beans) and in one very small study of more advanced fluctuating PD patients, it provided more “on” time without worsening dyskinesias, as compared with standard carbidopa/levodopa.
  • The problem with having patients take a natural supplement like this is the variability and consistency of the preparation. Given that is not currently available, it is not recommended that patients take this.
  • Complementary and alternative therapies will continue to be used by both younger and older patients with PD. The important thing to consider with these therapies is the cost and potential adverse effects given, that most of them are unproven.
References: 

Hauser RA, Lyons KE, McClain T, Carter S, Perlmutter D.  Randomized, double-blind pilot evaluation of intravenous glutathione in Parkinson’s disease.  Mov Disord. 2009; 24(7):979-983.

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):1672-1677.

Kim SR, Lee TY, Kim MS, Lee MC, Chung SJ.  Use of complementary and alternative medicine by Korean patients with Parkinson’s disease.  Clin Neurol Neurosurg. 2009; 111:156-160.

Suchowersky O, Gronseth G, Perlmutter J, Reich S, Zesiewicz T, Weiner WJ; Quality Standards Subcommittee of the American Academy of Neurology.  Practice Parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2006; 66(7):976-982.