Effect of acupuncture treatment on depression, one of the non-motor psychiatric symptoms of Parkinson’s disease

Psychiatric symptoms are common in Parkinson’s disease (PD), occur at higher prevalence than in age-matched controls and have significant impact on quality of life. However psychiatric symptoms are often underrecognized in clinical practice because of the lack of spontaneous complaints from patients. Depression is one of the most common psychiatric symptoms occurring in PD patients. PD patients with depression feel sad, anxiety, irritable and restless, and may lose interest in activities once enjoyable etc. The causes of depression in PD patients are not clear but the decreased levels of serotonergic and noradrenergic and dopaminergic neurotransmission in brain are implicated as relevant factors.

In clinical studies, one of the prominent responses to acupuncture treatment in PD patients, is the reported effect on depression. Many patients experienced great improvement in their symptoms and this is reflected on the results of Beck Depression Inventory, one of the most widely used instruments for measuring severity of depression, which showed a significant decrease in the scores in patients with acupuncture therapy compared with control treatment group. It has been reported that acupuncture stimulation caused activation of serotonergic neurons in the dorsal raphe neuclei in the midbrain leading to elevated levels of serotonin which is confirmed by neuroimaging studies.

Reference:

ML Eng et al., (2006) Journal of Alternative and Complementary Medicine, Vol. 12, 395-399. 
http://www.ncbi.nlm.nih.gov/pubmed/?term=eng+ml%2C+acupuncture%2C+parkinson%27s

Potential mechanisms of acupuncture therapy to alleviate motor symptoms in Parkinson’s disease

Although the potential benefits of acupuncture on patients with Parkinson’s disease (PD) have gained increasing attention, there is surprisingly little research on the mechanisms of acupuncture on the treatment of PD, in particular motor symptom relieve. Recently a paper reviewed the current development in acupuncture research in the models of PD. It has been reported that acupuncture stimulation at the assigned acupoints protected dopaminergic neurones in the substantia nigra in the middle brain against toxic insults and restored dopamine expression in the striatum, a brain area playing a pivotal role in modulating movement. More studies revealed that the effects of acupuncture-induced neuroprotection are mediated by stimulating expression of neurotrophic factors in the substantia nigra and striatum. Acupuncture therapy slows cell death process by acting as antioxidant agent to protect dopamine neurones against oxidative stress-induced neurodegeneration. In addition, acupuncture stimulation inhibited expression of inflammation markers in the relevant brain regions and enhanced its protective effects.  Further, studies on neuronal activity of motor circuits in the brain reported that acupuncture rebalanced output of neuronal activity and improved behavioural functions in Parkinson’s models. The results of those studies suggest that early application of acupuncture treatment to PD patients may be helpful in slowing down cell death process in Parkinson’s disease.

Reference:

BY Zeng et al., (2013) Current development of acupuncture research in Parkinson's disease. In BY Zeng, K Zhao & FR Liang (Eds), Neurobiology of Acupuncture (Int Rev Neurobiol. Vol. 111: pp. 141-58). New York: Academic Press. http://www.ncbi.nlm.nih.gov/pubmed/24215923

Clinical study of acupuncture therapy for Parkinson's disease

Acupuncture is an effective treatment for Parkinson’s disease. Manual- or electro-acupuncture treatment reliefs both motor symptoms and many non-motor symptoms. There have been a few clinical studies of acupuncture therapy for Parkinson’s in the past 10 years. Although the results are encourage but remain inconclusive due to many factors such as smaller number of patients recruited, study design with many flaws. Recently, a clinical study, aimed to investigate the efficacy of acupuncture as an alternative therapy for Parkinson’s, has been carried out, with 43 patients with Parkinson’s disease, the largest number of patients recruited in a single study so far. The patients in the treatment group underwent acupuncture treatment twice a week for 8 weeks. The patients in control group did not receive any treatment. The results showed that the PD patients in treatment group experienced significantly greater improvement on the Unified Parkinson’s disease rating scales (UPDRS), including total UPDRS scores and part III scores which assess individual’s motor function such as rigidity, finger tapping, hand movements, arising from chair and gait etc. In addition, patients receiving acupuncture showed a significant improvement on Beck’s Depression Inventory (BDI), an assessment about the depression. However, patients in control groups did not show any significant changes in both UPDRS and BDI assessments.

Although the number of patients participated in this clinical study is still quite smaller compared other clinical studies, its results are promising, indicating acupuncture treatment could improve both motor and non-motor symptoms of patients with Parkinson’s disease.

Reference:

SY Cho et al., (2012) Parkinsonism and Related Disorders 18, 948e952.
http://www.ncbi.nlm.nih.gov/pubmed/22632852

Acupuncture treatment for Parkinson's disease

Parkinson’s disease is an age-related, progressive neurodegenerative disorder that affects approximately 1 in 1000 population over age of 60 years. PD is caused by inability of brain to produce dopamine, a neurotransmitter that affects the regulation of movement and our mood as well. The main motor symptoms of PD include slow movement, resting tremor, muscular rigidity, postural imbalance. The non-motor symptoms are found in majority of PD patients and consist of autonomic dysfunction, neuropsychiatric disturbance, sleep disorders and gastrointerestinal symptoms and many others. Clinic treatment with levodopa, the precursor of dopamine, provides only a symptomatic relief with limited time rather a cure. Long-term treatment with levodopa induces advert effect such as motor fluctuation and dyskinesia within approximately 50% of patients with PD within 3-5 years following medication.

Acupuncture is one of the most popular types of complementary medicines because it has been reported to be a very safe and well-tolerated treatment with only minor side effects. Many patients with PD are reported using acupuncture as an alternative treatment at some points of their life. It has been estimated that more than a quarter of patients with PD in the United States (40%), Britain (38.7%), Singapore (61%) and Argentina (25.7%) have used at least one form of complementary medicine for PD, while 7-49% of them have used acupuncture as an alternative therapy. Recently it has been reported that acupuncture treatment to patients with PD significantly improved the motor function of affected hand following acupuncture treatment. Brain functional magnetic resonance image (fMRI), a non-invasive technique, revealed that the putamen and the primary motor cortex, the areas associated with motor functions, were activated when PD patients received acupuncture treatment and these activations correlated with individual enhanced functions. These studies showed that acupuncture treatment is effective in improving the motor symptoms of PD.

Reference:

Y Chae et al., (2009) Movement Disorders, Vol. 24, 1794–1802. http://www.ncbi.nlm.nih.gov/pubmed/19533753