Parkinson

In Parkinson’s disease, the neuronal cells that produce the neurotransmitter dopamine deteriorate. As a consequence, dopamine levels decline and symptoms appear. Treatment has traditionally involved dopamine’s chemical precursor, L-dopa. Although widely used, this treatment is accompanied by unpleasant toxic effects and causes only symptomatic relief while the disease progresses. The legume Mucuna pruriens (L) DC. (Fabaceae) has been used in Ayurveda as a naturopathic medicine for the treatment of Parkinson’s disease (then known as Kampavata). The results from more recent clinical studies suggest that this nutraceutical may be more effective than L-dopa against the symptoms of Parkinson’s disease, may possess neuroprotective properties, and may even cure patients suffering from this condition.

            Parkinson’s disease was named after the English medical doctor, James Parkinson, who in 1817 was the  first person to describe the symptoms as “the shaking palsy.” These symptoms were supposedly caused by a deficiency in the neurotransmitter dopamine. A neurotransmitter is a chemical messenger between nerve cells. Parkinson’s disease patients, as a result of dopamine deficiency, suffer from increased motor behavior impairment, usually at an older age. Based on the first symptoms, however, diagnosis can be difficult since at that point symptoms are often non-specific and can include weakness, tiredness, and fatigue. Consequently the disease may be unrecognized for some time. The primary symptoms of Parkinson’s disease include: muscular rigidity, resting tremor, difficulty with movement initiation (bradykinesia), slowed voluntary movement, difficulty with balance, and difficulty with walking. Next to Parkinson’s disease’s primary symptoms mentioned above, a patient may also start to suffer from secondary symptoms which include: depression, senility, postural deformity, and difficulty in speaking. Regardless of these primary and secondary symptoms, impairment of hand functions during daily activities to be the most disabling symptoms in Parkinson’s disease.

             The objective for management of Parkinson’s disease is often to attempt to keep the individual functionally active and independent as long as possible. The role of exercise and relaxation (e.g. yoga) at all stages of the disease is emphasized, and patient and caregiver are educated about the conditions and options. When the need for pharmacologic therapy arises, the appropriate drug is selected, starting with a low dose and increasing it very slowly. L-dopa is the best available remedy currently known to ease the lives of Parkinson’s patients. However, it is not a cure, because this treatment aims to increase dopamine levels and not stop the further deterioration of dopaminergic cells, and hence it does not work well in the long term. Long term use of L-dopa frequently results in fading of the therapeutic effect and the development of serious side effects such as further motor impairment and psychiatric complications.

Side effects of L-dopa toxicity are such as nausea, vomiting, diarrhea, weight loss, anorexia, skin lesions, orthostatic hypotension resulting in dizziness and in some cases staggering, and increased heart rate. Most side effects could be explained by the presence of the enzyme AADC, which converts L-dopa to dopamine, in the liver, kidney and many other places in the body. Thus, while the dopamine levels in the striatum (subcortical part of the forebrain) become more normal, the extra dopamine production disturbs chemical balances elsewhere in the body. To bypass the problem of the side effects of L-dopa treatment, researchers started to synthesize compounds that would directly act on dopamine receptors. These compounds, called receptor agonists, would take over the role of dopamine, so that no administration of L-dopa would be needed. This would counter side effects induced by large amounts of L-dopa. In reality, however, the dynamics are more complicated and require further investigation.

Traditional treatment of Parkinson’s disease

The shaking palsy has existed in different parts of the world since ancient times. The first clear description is found in the ancient Indian medical system of Ayurveda under the name Kampavata.  ), the ancient medical science being practiced in India from the Vedic times (1500–1000 BC), Ayurveda (“knowledge concerning longevity”), used plant tissues as medicine and the powder of Mucuna pruriens. M. pruriens is a climbing legume that originates in southern China and eastern India. The genus thrives under warm, moist conditions, below 1500m above sea level, and in areas with plentiful rainfall. It is currently widely available in most tropical regions of Asia, South and Central America, and Africa. The holistic approach of Ayurveda takes advantage of the known and unknown active biochemical ingredients of the plant tissue. The disadvantages are the bulkiness of the preparation and difficulty in its administration. Thus, extracts of such medicinal preparations need to be made available in a user friendly form. The clinical features and treatment of Kampavata (“kampa” = tremors) resembling Parkinson’s disease are also mentioned in Ayurveda. The various signs and symptoms of Kampavata are found in Caraka Samhita (written by Atreya in 2500 BC) and Madhavanidhani. These include rigidity, tremors of hands and feet, head tremor, drooling of saliva, love of solitude (depression), somnolence, reptilian stare, stammering, tremors of hands and feet, difficulty in body movements, disturbed sleep and dementia.  Ayurveda described several formulations for the treatment of Kampavata. Nearly 18 of these contain M. pruriens (known as Atmagupta in Sanskrit).