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NCCIH Clinical Digest

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Parkinson’s Disease and Complementary Health Approaches:
What the Science Says

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December 2016
Clinical Guidelines, Scientific Literature, Info for Patients: 

Mind and Body Practices

Tai Chi

There is some evidence that tai chi, along with medication, may improve some symptoms of Parkinson’s disease, such as balance and functional mobility.

The Evidence Base

  • The evidence base on efficacy of tai chi for symptoms of Parkinson’s disease consists of several randomized controlled trials and systematic reviews and meta-analyses.

Efficacy

  • A 2015 systematic review and meta-analysis of 15 randomized controlled trials involving 799 participants found positive evidence of tai chi plus medication for Parkinson’s disease for improvements in motor function, balance, and functional reach; however, no significant difference was found between tai chi plus medication and medication alone for gait or quality of life.
  • A 2015 systematic review of 64 studies of nonpharmacologic approaches to improve balance in Parkinson’s disease found some evidence that tai chi may help improve balance and motor control abilities; however, a 2013 randomized controlled trial showed that 16 weeks of tai chi training were ineffective in gait performance, gait initiation, or the reduction of disability related to Parkinson’s disease.
  • A 2014 systematic review and meta-analysis of seven randomized controlled trials and one non-randomized controlled trial involving a total of 470 participants found that tai chi showed beneficial effects in improving motor function, balance, and functional mobility in participants with Parkinson’s disease, but not in improving gait velocity, step length, or gait endurance. However, when compared to other active therapies, tai chi only showed better effects in improving balance.
  • A 2014 systematic review and meta-analysis of 10 randomized controlled trials involving a total of 409 participants with mild-to-moderate Parkinson’s disease concluded that tai chi, performed with medication, resulted in improvements in mobility and balance.

Safety

  • Tai chi is generally considered safe for most people. A 2014 systematic review and meta-analysis of 10 randomized controlled trials concluded that tai chi was safe and popular among participants with Parkinson’s disease who are at an early stage of disease.

Acupuncture

Clinical studies in China have shown a positive benefit of acupuncture in treating symptoms of Parkinson’s disease; however, large and well-controlled clinical trials are needed before a conclusion about the efficacy of acupuncture for this condition can be drawn. The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that there is insufficient evidence to support or refute the use of acupuncture in Parkinson’s disease.

The Evidence Base

  • The evidence base on efficacy of acupuncture on symptoms of Parkinson’s disease consists of a couple of reviews of only a few clinical trials of poor methodological quality.

Efficacy

  • The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that there is insufficient evidence to support or refute the use of acupuncture in Parkinson’s disease.
  • A 2015 systematic review and meta-analysis of 27 studies involving 2,314 participants evaluating the effectiveness of traditional Chinese medicine as an adjunct therapy for Parkinson’s disease found that acupuncture (based on 2 studies of 98 participants) as adjunct therapy was markedly beneficial for improving some Parkinson’s-related symptoms compared to routine treatment alone.
  • A 2014 review of 11 studies concluded that the lack of randomized controlled trials and small sample size were not sufficient to demonstrate favorable effects of acupuncture on Parkinson’s disease.

Safety

  • Acupuncture is generally safe and well-tolerated in most people when it is performed by a licensed practitioner.

Massage Therapy

There is insufficient evidence to determine whether massage therapy has any beneficial effect on symptoms of Parkinson’s disease.

The Evidence Base

  • The evidence base on efficacy of massage therapy for symptoms of Parkinson’s disease consists of only a few small clinical trials.

Efficacy

  • The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that there is insufficient evidence to support or refute manual therapy, including massage therapy, biofeedback, or Alexander technique in the treatment of Parkinson’s disease.
  • A 2013 randomized controlled pilot study of 45 participants with Parkinson’s disease found that salivary cortisol (a natural biomarker for stress) concentrations were significantly reduced immediately following the tactile massage intervention, but there were no significant differences in reduction compared to the control group and no long-term effect.

Safety

  • Massage therapy is generally safe and well-tolerated in most people when it is performed by a licensed practitioner.

Dance

There is some limited evidence that dance, such as the Argentine tango, can be a supportive approach for people with Parkinson’s disease and has the potential to improve specific symptoms of Parkinson’s, including motor severity and balance over the short term.

The Evidence Base

  • The evidence base on efficacy of dance interventions for symptoms of Parkinson’s disease consists of several randomized controlled trials and a few systematic reviews and meta-analyses. Most studies have been small and have been less rigorous in design.

Efficacy

  • A 2015 systematic review and meta-analysis of 13 studies evaluated research results on the effectiveness of Argentine tango for people with Parkinson’s disease and found significant overall effects in favor of tango for motor severity and balance. However, the studies were small and many were conducted by the same research groups.
  • A 2013 clinical trial involving 31 participants examined the effects of adapted tango on spatial cognition and disease severity in Parkinson’s disease and found that the tango participants improved on disease severity and spatial cognition, compared with the control group. Improvements among the tango participants were also seen in balance and executive function.
  • A 2013 randomized controlled trial of 52 participants with Parkinson’s disease found that those who participated in a community-based Argentine tango class reported increased participation in complex daily activities, recovery of activities lost since the onset of Parkinson’s disease, and engagement in new activities.
  • When comparing the differential effects of tango versus other types of dance for Parkinson’s disease, a 2015 study of 11 participants concluded that tango dance interventions may preferentially improve mobility and motor signs in people with Parkinson’s disease, compared to other dance interventions.
  • A 2015 randomized controlled trial of 20 participants examined the effects of virtual reality dance exercise on people with Parkinson’s disease and found that virtual reality dance exercise had a positive effect on balance, activities of daily living, and depressive disorder status.
  • A 2014 systematic review and meta-analysis of five randomized controlled trials found that dance as an intervention for Parkinson’s disease significantly improved motor scores, balance, and gait speed when compared to no treatment. When compared with other exercise interventions, significant improvements in balance and quality of life were found.

Safety

  • Dance interventions in people with Parkinson’s disease are generally considered safe when practiced in a controlled environment. Dancing with a partner may provide an added safety element in preventing falls by holding on to the partner.

Natural Products

Coenzyme Q10

The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that there is insufficient evidence to support or refute the use of coenzyme Q10 for neuroprotection.

The Evidence Base

  • The evidence base on efficacy of coenzyme Q10 for Parkinson’s disease consists of a few clinical trials.

Efficacy

  • The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that there is insufficient evidence to support or refute the use of coenzyme Q10 for neuroprotection. The guidelines state, “Three single Class I studies using UPDRS as the outcome measure suggest there is no evidence of neuroprotection for riluzole, coenzyme Q, or pramipexole (as compared to levodopa). However, the studies of riluzole and coenzyme Q were underpowered to rule out a possible benefit, particularly if modest.”
  • A 2014 randomized clinical trial of 600 participants with Parkinson’s disease concluded that coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit.
  • A 2002 randomized controlled trial of 80 participants with early Parkinson’s disease found that less disability developed in subjects assigned to coenzyme Q10 than in those assigned to placebo; however, the results did not reach statistical significance.

Safety

  • Studies have not reported serious side effects related to CoQ10 use. The most common side effects of CoQ10 include insomnia, increased liver enzymes, rashes, nausea, upper abdominal pain, dizziness, sensitivity to light, irritability, headaches, heartburn, and fatigue.
  • CoQ10 may make warfarin less effective.

Creatine

There is insufficient evidence to determine whether creatine used alone or as an adjuvant treatment is efficacious for Parkinson’s disease.

The Evidence Base

  • The evidence base on the efficacy of creatine for Parkinson’s disease consists of only a few small randomized controlled trials and a Cochrane systematic review.

Efficacy

  • A 2014 Cochrane systematic review of 2 randomized controlled trials involving 194 participants concluded that the evidence base on the effects of creatine in Parkinson’s disease is limited by risk of bias, small sample sizes, and short duration of clinical trials, and does not provide a reliable basis on which treatment decisions can be made.

Safety

  • The Cochrane systematic review found that creatine appears to be safe and well-tolerated; however, there was a higher rate of patients with gastrointestinal complaints in the creatine group compared to the placebo group at 2 years followup.

Mucuna pruriens (Velvet bean)

There is insufficient evidence to support or refute the use of Mucuna pruriens for the treatment of Parkinson’s disease symptoms.

The Evidence Base

  • The evidence base on efficacy of Mucuna pruriens on symptoms of Parkinson’s disease consists of only one preliminary pilot study.

Efficacy

  • The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that there is insufficient evidence to support or refute the use of Mucuna pruriens for the treatment of motor symptoms of Parkinson’s disease.
  • A 2004 preliminary pilot study of eight participants with Parkinson’s disease with a short duration L-dopa response  and disabling peak dose dyskinesias found that the seed powder formulation of Mucuna pruriens contains a considerable quantity of L-dopa and has a rapid onset of action with a slightly longer duration of therapeutic response compared with standard L-dopa. Mucuna pruriens’s long-term efficacy and safety has not yet been established.

Safety

  • The safety of Mucuna pruriens has not yet been established.

Vitamin E

The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that Vitamin E is probably ineffective for the treatment of Parkinson’s disease.

The Evidence Base

  • The evidence base on efficacy of vitamin E for the treatment of Parkinson’s disease consists of only a few clinical trials.

Efficacy

  • The American Academy of Neurology’s practice parameter on neuroprotective strategies and alternative therapies for Parkinson’s disease concluded that vitamin E is probably ineffective for the treatment of Parkinson’s disease and recommended that for patients with Parkinson’s disease, vitamin E should not be considered for symptomatic treatment.
  • A large 1993 clinical trial involving 800 participants with early stage Parkinson’s disease evaluated the effects of deprenyl (a monoamine oxidase inhibitor) and tocopherol (a component of vitamin E) on the progression of disability and found that tocopherol did not delay the onset of disability associated with Parkinson’s.

Safety

  • High doses of alpha-tocopherol supplements can cause hemorrhage and interrupt blood coagulation in animals, and in vitro data suggest that high doses inhibit platelet aggregation.
  • Results from a large SELECT trial show that vitamin E supplements (400 IU/day) may harm adult men in the general population by increasing their risk of prostate cancer. Followup studies are assessing whether the cancer risk was associated with baseline blood levels of vitamin E and selenium prior to supplementation as well as whether changes in one or more genes might increase a man’s risk of developing prostate cancer while taking vitamin E.

References

  • Foster ER, Golden L, Duncan RP, et al. Community-based Argentine tango dance program is associated with increased activity participation among individuals with Parkinson’s disease. Arch Phys Med Rehabil. 2013;94(2):240-249.
  • 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 HJ, Jeon BS. Is acupuncture efficacious therapy in Parkinson’s disease? J Neurol Sci. 2014;341(1-2):1-7.
  • Klein EA, Thompson IM Jr, Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306(14):1549-1556.
  • Lee NY, Lee DK, Song HS. Effect of virtual reality dance exercise on the balance, activities of daily living, and depressive disorder status of Parkinson’s disease patients. J Phys Ther Sci. 2015;27(1):145-147.
  • Lötzke D, Ostermann T, Büssing A. Argentine tango in Parkinson disease—a systematic review and meta-analysis. BMC Neurol. 2015;15:226.
  • McKee KE, Hackney ME. The effects of adapted tango on spatial cognition and disease severity in Parkinson’s disease. J Mot Behav. 2013;45(6):519-529.
  • McNeely ME, Mai MM, Duncan RP, et al. Differential effects of tango versus dance for PD in Parkinson disease. Front Aging Neurosci. 2015;7:239.
  • Ni X, Liu S, Lu F, et al. Efficacy and safety of Tai Chi for Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(6):e99377.
  • Parkinson Study Group QE3 Investigators, Beal MF, Oakes D, et al. A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol. 2014;71(5):543-552.
  • Parkinson Study Group. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson’s disease. N Engl J Med. 1993;328(3):176-183.
  • Sharp K, Hewitt J. Dance as an intervention for people with Parkinson’s disease: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2014;47:445-456.
  • Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. 2002;59(10):1541-1550.
  • Suchowersky O, Gronseth G, Perlmutter J, et al. Practice parameter: Neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review). Neurology. 2006;66(7):976-982.
  • Sumec R, Filip P, Sheardova K, et al. Psychological benefits of nonpharmacological methods aimed for improving balance in Parkinson’s disease: a systematic review. Behav Neurol. 2015;2015:620674.
  • Törnhage CJ, Skogar Ö, Borg A, et al. Short- and long-term effects of tactile massage on salivary cortisol concentrations in Parkinson’s disease: a randomised controlled pilot study. BMC Complement Altern Med. 2013;13:357.
  • Xiao Y, Luo M, Luo H, et al. Creatine for Parkinson’s disease. Cochrane Database of Systematic Reviews. 2014;6:CD009646.
  • Yang Y, Li XY, Gong L, et al. Tai Chi for improvement of motor function, balance and gait in Parkinson’s disease: a systematic review and meta-analysis. PLoS One. 2014;9(7):e102942.
  • Yang Y, Qiu WQ, Hao YL, et al. The efficacy of traditional Chinese Medical Exercise for Parkinson’s disease: a systematic review and meta-analysis. PLoS One. 2015;10(4):e0122469.
  • Zhang G, Xiong N, Zhang Z, et al. Effectiveness of traditional Chinese medicine as an adjunct therapy for Parkinson’s disease: a systematic review and meta-analysis. PLoS One. 2015;10(3):e0118498.

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH Web site at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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This page last modified December 16, 2016