Use of complementary and alternative therapies in outpatients with Parkinson's disease in Argentina.

Abstract

We interviewed 300 patients (54.7% male; mean age was 65.8 ± 9.5) attending the Movement Disorders Clinic at the Buenos Aires University Hospital to determine the prevalence of CATs use and their association with demographic, social, or disease-specific characteristics among patients with Parkinson's disease (PD) in Buenos Aires, Argentina. We found that 25.7% of the PD patients interviewed (77/300) stated they had used CATs to improve their PD symptoms whereas 38.0% (114/300) had used some CATs without any relation to PD, at least once in life. At the moment of the interview, CATs prevalence use was 50.6% in the former group and 25.0% in the latter. The use of CATs was much more frequent among women and more common in the 50- to 69-year age group. Friends and neighbors of the patients had most frequently recommended these therapies. No major association was observed between CATs use and the duration of the disease, side of initial involvement, PD phenotype, or the Hoehn and Yahr staging. Acupuncture, homeopathy, yoga, and therapeutic massage were the most widely used therapies. After the initiation of conventional treatment the use of massage, yoga, and acupuncture in patients using CATs to improve PD significantly increased. Neurologists should be aware and inquire about the use of CATs to rule out potentially harmful effects.

Mov Disord. 2010 Oct 15;25(13):2094-8.

Pecci C, Rivas MJ, Moretti CM, Raina G, Ramirez CZ, Díaz S, Uribe Roca C, Micheli FE. Parkinson's Disease and Movement Disorders Unit, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina.

Potential influences of complementary therapy on motor and non-motor complications in Parkinson's disease.

Abstract

Nearly two-thirds of patients with Parkinson's disease (PD) use vitamins or nutritional supplements, and many more may use other complementary therapies, yet <50% of patients have discussed the use of these complementary therapies with a healthcare professional. Physicians should be aware of the complementary therapies their patients with PD are using, and the possible effects of these therapies on motor and non-motor symptoms. Complementary therapies, such as altered diet, dietary supplements, vitamin therapy, herbal supplements, caffeine, nicotine, exercise, physical therapy, massage therapy, melatonin, bright-light therapy and acupuncture, may all influence the symptoms of PD and/or the effectiveness of dopaminergic therapy. Preliminary evidence suggests complementary therapy also may influence non-motor symptoms of PD, such as respiratory disorders, gastrointestinal disorders, mood disorders, sleep and orthostatic hypotension. Whenever possible, clinicians should ensure that complementary therapy is used appropriately in PD patients without reducing the benefits of dopaminergic therapy.

CNS Drugs. 2009 Oct 1;23(10):817-35..Zesiewicz TA, Evatt ML.

SourceDepartment of Neurology, University of South Florida, Tampa, 33612, USA. tzesiewi@health.usf.edu

Efficacy and safety of acupuncture for idiopathic Parkinson's disease: a systematic review.

Abstract

OBJECTIVES: To assess the efficacy and safety of acupuncture therapy (monotherapy or adjuvant therapy), compared with placebo, conventional interventions, or no treatment in treating patients with idiopathic Parkinson's disease (IPD).

DATA SOURCES: International electronic database: (1) The Cochrane Controlled Trials Register, (2) Academic Search Premier, (3) ACP Medicine, Alternative Medicine, (4) CINAHL, (5) EBM Reviews, (6) EMBASE, (7) MEDLINE, (8) OLD MEDLINE, (9) ProQuest Medical Library. Chinese electronic databases searched included: (1) VIP, (2) CJN, (3) CBM disk, (4) China Medical Academic Conference. Hand searching was conducted on all appropriate journals. Reference lists of relevant trials and reviews were also searched to identify additional studies.

SELECTION CRITERIA: All randomized controlled trials (RCTs) of any duration comparing monotherapy and adjuvant acupuncture therapy with placebo or no intervention were included.

DATA COLLECTION AND ANALYSIS: Data were abstracted independently by Y. C. Lam and S. C. Man onto standardized forms, and disagreements were resolved by discussion.

MAIN RESULTS: Ten (10) trials were included, each using a different set of acupoints and manipulation of needles. None of them reported the concealment of allocation. Only two mentioned the number of dropouts. Two (2) used a nonblind method while others did not mention their blinding methods. Nine (9) studies claimed a statistically significant positive effect from acupuncture as compared with their control; only one indicated that there were no statistically significant differences for all variables measured. Only 2 studies described details about adverse events.

CONCLUSIONS: There is evidence indicating the potential effectiveness of acupuncture for treating IPD. The results were limited by the methodological flaws, unknowns in concealment of allocation, number of dropouts, and blinding methods in the studies. Large, well-designed, placebo-controlled RCTs with rigorous methods of randomization and adequately concealed allocation, as well as intention-to-treat data analysis are needed.

J Altern Complement Med. 2008 Jul;14(6):663-71

Lam YC, Kum WF, Durairajan SS, Lu JH, Man SC, Xu M, Zhang XF, Huang XZ, Li M.

School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong.

Complementary and alternative medicine use for treatment and prevention of late-life mood and cognitive disorders.

Abstract

Late-life mood disorders and cognitive aging are the most common reasons for using complementary and alternative therapies. The amount of rigorous scientific data to support the efficacy of complementary therapies in the treatment of depression or cognitive impairment is extremely limited. The areas with the most evidence for beneficial effects are exercise, herbal therapy (Hypericum perforatum), the use of fish oil, and, to a lesser extent, acupuncture and relaxation therapies. There is a need for further research involving randomized, controlled trials to investigate the efficacy of complementary and alternative therapies in the treatment of depression and cognitive impairment in late-life. This research may lead to the development of effective treatment and preventive approaches for these serious conditions.

Aging health. 2009 Feb 1;5(1):61-78.

Lavretsky H  Associate Professor of Psychiatry, Department of Psychiatry & Biobehavioral Sciences, and, Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, Tel.: +1 310 794 4619, , hlavrets@ucla.edu.

Acupuncture in the treatment of paralysis in chronic and acute stroke patients--improvement correlated with specific CT scan lesion sites.

Abstract

A total of 20 stroke patients received acupuncture, including 10 chronic and 10 acute patients; 19 of the 20 patients (95%) could be correctly classified regarding beneficial response to acupuncture, versus poor response, based on CT scan lesion site data, alone. Patients with beneficial response had damage to less than half of the motor pathway areas on CT scan, especially in the periventricular white matter area (PVWM) at the level of the body of the lateral ventricle. Overall, 8 of the 20 patients receiving acupuncture had beneficial response with measurable objective improvement in motor function, including 3 of the 10 chronic patients treated at > 3 months poststroke, and 5 of the 10 acute patients treated at < 3 months poststroke. Among the 8 patients with beneficial response, significant improvements were observed in knee flexion, knee extension, and shoulder abduction. Neither age, nor months poststroke when acupuncture was begun, was significantly correlated with the total number of improved tests, post-acupuncture. Two chronic patients with beneficial response first began receiving acupuncture at 3 years and 6 years poststroke. Most improvements were sustained for at least 4 months after the last acupuncture treatment.

Acupunct Electrother Res. 1994 Oct-Dec;19(4):227-49.

Naeser MA, Alexander MP, Stiassny-Eder D, Galler V, Hobbs J, Bachman D.

Boston University School of Medicine, MA, USA.

Open-label trial regarding the use of acupuncture and yin tui na in Parkinson's disease outpatients: a pilot study on efficacy, tolerability, and quality of life.

Abstract

OBJECTIVES:

This study evaluates the effects of sequential tui na massage, acupuncture, and instrument-delivered qigong for patients with Parkinson disease (PD) over a 6-month period.

DESIGN:

Patients received weekly treatments, which included tui na massage prior to acupuncture followed by instrument-delivered qigong. Each patient was assessed at baseline and at 6 months.

SETTING:

The setting was an outpatient research/academic clinic for patients with PD and nonacademic acupuncture clinic.

SUBJECTS:

Twenty-five (25) patients with idiopathic PD were the subjects.

OUTCOME MEASURES:

Before and after treatment patients were evaluated with the Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr Staging (H&Y), Schwab and England Activities of Daily Living (S & E), Beck Depression Inventory (BDI), Parkinson's Disease Questionnaire (PDQ-39) quality of life assessment, and patient global assessments.

RESULTS:

There were no significant improvements in treatment measures; however, there was a 2.4-point worsening in UPDRS motor scores (24.0 versus 26.4, p = 0.018). There was a 16% improvement in the PDQ- 39 total score (23.2 versus 19.6, p = 0.044) and a 29% improvement in the BDI (9.6 versus 6.8, p = 0.006). Sixteen (16) patients reported moderate to marked improvement. There were no adverse effects.

CONCLUSIONS:

Acupuncture is safe and well tolerated in patients with PD. Most patients reported subjective improvement. The BDI and PDQ-39 total score, measuring depression and quality of life, demonstrated some improvement, but UPDRS motor scores worsened.

J Altern Complement Med. 2006 May;12(4):395-9.

Eng ML, Lyons KE, Greene MS, Pahwa R.

University of Kansas Medical Center, University of Kansas, School of Pharmacy, Department of Pharmacy Practice, Kansas City, KS 66160-7231, USA. meng@kumc.edu

Acupuncture therapy for the symptoms of Parkinson's disease.

Abstract

Interest in alternative medical treatments, including acupuncture, is increasing. Alternative treatments must be subjected to the same objective standards as all medical treatments. A non-blinded pilot study of the safety, tolerability, and efficacy of acupuncture (ACUPX) for the symptoms of (PD) was performed. Twenty PD patients (mean age, 68 years; disease duration, 8.5 years; Hoehn and Yahr [H&Y] stage, 2.2; Unified Parkinson's Disease Rating Scale score [UPDRS], 38.7) each received acupuncture treatments by a licensed acupuncturist. All patients were treated with two acupuncture treatment sessions per week. The first seven patients received 10 treatments and the last 13 patients 16 treatments. Patients were evaluated before and after ACUPX with the Sickness Impact Profile (SIP); UPDRS; H & Y; Schwab and England (S & E); Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI); quantitative motor tests, including timed evaluations of arm pronation supination movements, finger dexterity, finger movements between two fixed measured points, and the stand-walk-sit test; and a patient questionnaire designed for the study. Following ACUPX, there were no significant changes in the UPDRS, H&Y, S&E, BAI, BDI, quantitative motor tests, total SIP or the two SIP Dimension scores. Analysis of the 12 SIP categories not corrected for multiple comparisons revealed a post-ACUPX improvement in the sleep and rest category only (P = 0.03). On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. ACUPX therapy is safe and well tolerated in PD patients. A range of PD and behavioral scales failed to show improvement following ACUPX other than sleep benefit, although patients reported other discrete symptomatic improvements. A broad battery of tests in PD patients suggested that ACUPX resulted in improvement of sleep and rest only. This finding needs to be verified using more in-depth and controlled evaluation of ACUPX for PD-related sleep disturbance.

Mov Disord. 2002 Jul;17(4):799-802.

Shulman LM, Wen X, Weiner WJ, Bateman D, Minagar A, Duncan R, Konefal J.

Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. lshulman@som.umaryland.edu