Synergistic effect of Chinese herbal medicine with l-dopa in treating Parkinson’s

Although conventional treatments such as l-dopa and many more markedly improved motor symptoms of Parkinson’s, long-term use is associated with severe adverse effects that could significantly impact on the quality of life of patients with Parkinson’s. Alternative therapies such as Chinese herbal medicine is proved to be as effective as conventional medicine but with markedly less side-effect.

Very recently Dr. Ahn S and colleagues investigated whether the modified Cheong-gan-tang (淸肝湯 CGT, KD5040) would have synergistic effects with l-dopa on motor function and reduce l-dopa-induced dyskinesia. Modified Cheong-gan-tang (淸肝湯, KD5040), consisting of Paeonia lactiflora Pall, Ligusticum chuanxiong Hort, Angelica gigas Nakai, Bupleurum falcatum Linne, Gardenia jasminoides Ellis, and Paeonia suffruticosa Andrews plus Eugenia caryophyllata Thunb and Pogostemon cablin Bentham was co-administered with l-dopa to the Parkinson’s mouse model.

It was shown that co-administration of CGT with low-dose l-dopa synergistically improved the motor function. In addition, it significantly reversed MPTP-induced lowering of substance P, improved enkephalin levels, both are neuropeptides involved in the motor regulation in the basal ganglia. Further, co-administration of both CGT and l-dopa ameliorated abnormal reduction in glutamate content in the motor cortex. Moreover, modified CGT significantly lowered abnormal involuntary movements and controlled l-dopa-induced abnormal levels of striatal FosB, pDARPP-32, pERK, and pCREB, which is the early gene expression pathway regulating occurrence of involuntary movement.

The findings of study suggested that modified CGT can be a possible candidate for adjunct therapy in treating motor dysfunction and dyskinesia in PD patients.

Reference

Ahn S et al., Effects of a combination treatment of KD5040 and L-dopa in a mouse model of Parkinson’s disease. BMC Complementary and Alternative Medicine (2017) 17:220.  https://www.ncbi.nlm.nih.gov/pubmed/28424060

Mechanisms underlying effect of GB34 acupoint in Parkinson’s disease

Although both clinical observation and model studies showed that stimulation of GB34 acupoint improved motor function in Parkinson’s, its mechanism behind is unclear. Very recently two reports of PD model studies shed the light on the question.

Dr. Tian and colleagues in China investigated the effect and mechanism of stimulating GB34 in PD model. They observed first that there was an aggregation of toxic protein, alpha-synuclein closely linked to PD, in the dopamine cells in the brain of PD model. Stimulation at GB34 promoted the autophagic clearance of alpha-synuclein, in a manner different from mammalian target of rapamycin (mTOR)-dependent pathway. Further improvement in the motor function at the behavior level of model was observed. Authors suggested that connection between acupuncture and autophagy not only provides a new route to understanding the molecular mechanism of acupuncture treatment in Parkinson’s.

Later, Dr. Park and colleagues in Korea conducted a series of in vitro and in vivo studies of Parkinson’s. Firstly they found that melanin-concentrating hormone (MCH) in hypothalamus of brain is a neuroprotective agent, then that MCH protected dopamine cells in both vitro and vivo studies. Further stimulation at GB34 activated hypothalamic MCH biosynthesis which can be blocked by MCH-R1 antagonist, then releasing MCH-activated MCH receptors (MCH-Rs) in the dopamine terminals, and showed dopaminergic neuroprotection. MCH is an important metabolic hormone that reportedly influences sleep control and affects learning and memory. About 80 % of patients with PD experienced sleep disturbances, and they showed substantial losses of MCH neurons in the hypothalamus. Moreover, this loss of MCH neurons has been significantly correlated with the clinical stages of PD and regarded as hypothalamic dysfunction in PD. This study suggested that acupuncture stimulation at GB34 activated MCH may play an important role in neuroprotection of Parkinson’s.

References

Tian T et al., Acupuncture promotes mTOR-independent autophagic clearance

of aggregation-prone proteins in mouse brain. Sci Rep. 2016 Jan 21;6:19714.    http://www.nature.com/articles/srep19714

Park JY et al., Novel Neuroprotective Effects of Melanin-Concentrating Hormone in Parkinson’s Disease. Mol Neurobiol. 2016 Nov 14.  https://www.ncbi.nlm.nih.gov/pubmed/27844281

Objective assessment of efficacy of electroacupuncture in the treatment of gait disorder in Parkinson’s disease

A report was just published to confirm the efficacy of electroacupuncture treatment on gait in patients with Parkinson’s, by using body-worn sensors, an objective monitoring device. The pilot study was published by journal PLOS one.

Parkinsonian gait is mainly characterized by general slow movement, in particular by a reduction of gait speed and stride length. The progressive nature of symptoms leads to the freezing of gait and falls. Parkinsonian gait tends to be difficult treated, as drug treatment and deep brain stimulation have limited efficacy. Acupuncture has been effectively used to relieve parkinsonian symptoms; however, its efficacy remains controversy.

Recently Dr. H Lei and colleagues in the United States conducted a clinical study by using wearable sensor technology, to objectively assess the efficacy of acupuncture treatment on gait in patients with Parkinson’s. PD patients were randomly allocated into real acupuncture group (n=10) and sham acupuncture group (n=5). In real group, electroacupuncture was applied on different acupoints on the scalp, body and limbs, for 30min, once a week for 3 weeks. In sham group, acupuncture needles were applied just under skin, ca 4mm at non-acupoints on the scalp, body and limbs without stimulation. The participants and assessors were masked to eliminate potential bias effect. Outcomes were monitored at baseline and after completion of treatments. Measurements included gait analysis perimeters. In addition, Unified Parkinson's Disease Rating Scale (UPDRS), short Falls Efficacy Scale-International (FES-I), and visual analog scale (VAS) for pain were utilized.

Results showed that electroacupuncture treatment statistically significantly improved gait symptoms judged by all gait objective measurements compared with sham acupuncture control group. In particular gait speed was markedly improved compared with sham control.

This was the first participants- and assessors- masked randomized control study that, using body-worn sensor technology to objectively assess potential benefits of EA in enhancing spatio-temporal parameters of gait in PD patients.

Reference

Lei H et al., A Pilot Clinical Trial to Objectively Assess the Efficacy of Electroacupuncture on Gait in Patients with Parkinson's Disease Using Body Worn Sensors. PLoS One. 2016 May 26;11(5):e0155613.   http://www.ncbi.nlm.nih.gov/pubmed/27227460 

Acupuncture helps improve both motor and non-motor symptoms of Parkinson’s disease

Literature review study found that acupuncture treatment alleviated both motor and non-motor symptoms of Parkinson’s disease according to a report published in journal of CNS Neuroscience and Therapeutics.

In this article, we have studied the clinical reports of acupuncture treatment for Parkinson’s, which were listed in Medline, PubMed, EMBASE, CNKI, and CINAHL databases in the past 15 years. It was found that acupuncture either manual or electroacupuncture stimulation at specific acupoints relieved some motor symptoms in patients with Parkinson’s and markedly improved many non-motor symptoms such as psychiatric disorders, sleep problems, and gastrointestinal symptoms. When it was used as an adjunct for levodopa, acupuncture improved therapeutic efficacy and reduced dosage and the occurrence of side effects of levodopa.

Although the evidence for the effectiveness of acupuncture for treating PD is inclusive, data from the reviewed studies showed that therapeutic potential of acupuncture in treating Parkinson’s seems rather promising. More studies, either comparative effectiveness research or high-quality placebo-controlled clinical studies should be conducted.

Reference

Zeng BY & Zhao K, Effect of Acupuncture on the Motor and Nonmotor Symptoms in

Parkinson’s Disease—A Review of Clinical Studies. CNS Neurosci Ther. 2016 Feb 4. doi: 10.1111/cns.12507.    http://www.ncbi.nlm.nih.gov/pubmed/26843036

Acupuncture alleviated gait disturbance in patients with Parkinson’s

Acupuncture stimulation at some specific acupoints relieved gait disturbance immediate after acupuncture in PD patients according to a report published in the Journal of American Geriatrics Society.

Gait disturbance is one of the most common symptoms of Parkinson’s. A typical parkinsonian gait is characterised as slower speed, shorter arm swings, shorter stride length, longer double support time and faster cadence than healthy individuals. Gait dysfunction is regarded as one of the important symptoms of Parkinson’s and affects the quality of life of patients with Parkinson’s.

Recently doctors in Japan conducted a small clinical study to assess the short-term effect of acupuncture on gait disturbance in Parkinson’s. Patients with Parkinson’s were given acupuncture at following acupoints: ST36, SP6, LV3, LI4 and LI11. Gait function in PD patients were measured using a portable gait rhythmogram, a small device that measures three dimensional accelerations affecting gait associated with voluntary limb and trunk movements before and after acupuncture.

It was found that after acupuncture stride length, walking acceleration and gait speed, indicators of gait function significantly increased compared the baseline.

Authors suggested that acupuncture was as good as or better than the conventional treatment with gait disturbance in Parkinson’s. However, clinical study with controlled and large sample size should be conducted to evaluate efficacy of acupuncture treatment.

Reference

S Fukuda et al., Acupuncture for Gait Disturbance in Parkinson's Disease: Immediate Effects of Acupuncture Treatment. J Am Geriatr Soc. 2015 Oct;63(10):2189-90.    http://onlinelibrary.wiley.com/doi/10.1111/jgs.13690/abstract

Acupuncture add-on treatment improved both motor and non-motor symptoms in Parkinson’s disease

Acupuncture plus anti-parkinsonian drug significantly improved motor symptoms and non-motor symptoms in patients with Parkinson’s, and particularly efficacious at early stage of Parkinson’s. Acupuncture add-on treatment also markedly reduced nitric oxide level serum compared with anti-parkinsonian drug along group. A clinical study was recently reported in the journal of Evidence-Based Complementary and Alternative Medicine.

Parkinson’s is caused by the loss of dopamine and other neurotransmitters in central nervous system and is characterized by the motor dysfunction such as bradykinesia, resting tremor, rigidity and gait and postural imbalance. Although many non-motor symptoms developed before or parallelly with motor symptoms they were not always diagnosed and properly treated. Anti-parkinsonian drugs such as dopamine agonists are used to treat motor-related symptoms and have some severe side effects e.g. involuntary movement; while many non-motor symptoms were left untreated or mistreated, leading to significantly downgrad the quality of life of the PD patients. 

Acupuncture has been used to treat resting tremor and many motor and non-motor symptoms. However efficacy of acupuncture treatment in Parkinson’s is inconsistent and controversial.

Recently researchers led by Dr. Z Wei in China carried out a clinical study to assess the efficacy of acupuncture add-on in PD in particular to evaluate on both motor and non-motor effect. Fifty patients with Parkinson’s treated with levedopa were divided into acupuncture add-on group (n=30) and drug alone group (n=20). While all patients were continually taking their route anti-parkinsonian drug levedopa, patients in acupuncture add-on group were given electroacupuncture at bilateral GF20, LI4 and central DU14 and DU16 for 30 each time, once every 3 days. Ten-treatment was a course and two course in total within 2 months. Outcome measures for both motor-function (UPDRS III scores) and non-motor conditions such as depression and sleep disturbance and questionnaire for quality of life were assessed before and after the treatment.

Data showed that acupuncture add-on treatment significantly improved many motor functions such tremor, bradykinesia, and rigidity and non-motor conditions e.g. depression and sleep disturbance compared with drug alone group. Biochemical studies revealed that many inflammatory-related markers such as TNF-alpha,IL-1beta,and PGE2 were significantly reduced in acupuncture add-on group compared with drug alone group.

Authors concluded that acupuncture add-on is effective on most motor symptoms and some non-motor symptoms in particular at the early stage of Parkinson’s. Anti-inflammatory effect may be the underlying mechanism of acupuncture add-on treatment in Parkinson’s.

Reference:

F Wang et al., Effect and Potential Mechanism of Electroacupuncture Add-On

Treatment in Patients with Parkinson’s Disease. Evidence-Based Complementary and Alternative Medicine, Volume 2015, Article ID 692795,11 pages.     http://www.hindawi.com/journals/ecam/2015/692795/

Acupuncture improved non-motor symptoms of Parkinson’s disease

Acupuncture treatment alleviated many non-motor symptoms of Parkinson’s including pain, depression, anxiety, hot flashes and paroxysmal sweating in a patients with Parkinson’s. This is a case report published in the journal of Case Reports of Neurological Medicine.

Non-motor symptoms occur in virtually all patients with Parkinson’s. Non-motor symptoms range from autonomic dysfunction, psychiatric disorders, sensory symptoms, gastrointestinal syndromes and many others. Acupuncture is very effective in relieving many non-motor symptoms without side-effect.

Recently Dr. Iseki and colleagues in Japan used acupuncture to treat multiple non-motor symptoms of a patient with PD. An 81-year-old woman with a 5-year history of right-dominant lower leg pain was admitted into the hospital. Although she was prescribed various kinds of pain killers her pain was not satisfactorily relieved. She was diagnosed with Parkinson’s 3 year ago due to her mask-like face and bradykinesia and around that time suffered from severe hot flashes and paroxysmal sweating which was not associated with the levodopa treatment. The patient was given acupuncture treatment 5 times per week for 2 weeks. Assessments including Visual Analogue Scale (VAS) for pain, Hamilton Depression Scale (HAM-D) for depression and the Unified Parkinson’s Disease Rating Scale (UPDRS) score were performed before and after acupuncture treatment.

It was found that immediately after every acupuncture session patient felt that her legs had become light. Two weeks after acupuncture her lower leg pain became milder. VAS scores were markedly reduced. The daily attack of hot flashes and paroxysmal sweating were decreased to about three time a week. Depression and anxiety were obviously lessened and HAM-D scores reduced from 18 to 9. The UPDRS total score reduced from 59 to 46. Her steps became larger and her bradykinesia was improved.

This is another report showing that acupuncture is beneficial to PD patients suffering from both non-motor and motor symptoms.

Reference

Iseki C et al.,  Acupuncture Alleviated the Nonmotor Symptoms of Parkinson's Disease including Pain, Depression, and Autonomic Symptoms. Case Rep Neurol Med. 2014;2014:953109. doi: 10.1155/2014/953109. http://www.hindawi.com/journals/crinm/2014/953109/ 

Acupuncture helps improving bladder dysfunction in Parkinson’s patients

Acupuncture in combination with lower dose of tolterodine not only significantly improved urinary function but the motor functions of Parkinson’s disease (PD) patients with overactive bladder syndrome. According to a report published in the journal of Chinese Acupuncture & Moxibustion.

Many PD patients developed some non-motor symptoms including bladder dysfunction such as overactive bladder syndrome – urinary frequency, urgency, and leakage which could be very severe and significantly impacted on patient’s quality of life. Conventional treatment for urinary dysfunction such as tolterodine can temporarily improve bladder function but has many unpleasant side effects.

Dr Chen Yi-Liang and colleagues in China carried out a clinical study to assess the therapeutic effect of acupuncture plus lower dosage of tolterodine on PD patients with overactive bladder syndrome. PD patients with overactive bladder syndrome were divided into two groups. Combination group (n=30) were treated with electroacupuncture (once a day, 6 time a week for 6 weeks), plus tolterodine 1mg, twice a day for 6 weeks. Drug group (n=30) was given tolterodine 2mg, twice a day for 6 weeks. Urinary functions and UPDRSIII scores were assessed before and after completion of treatment.

At the end of study although both groups showed significant improvement in urinary function, the improvement was greater in combination group. Moreover patients in combination group experienced better motor functions jugged by significant changes in UPDRSIII scores. The occurrence of side effects was also markedly less in combination group than those of drug only group.

The study showed that acupuncture indeed is a treatment for multi targets not only improve non-motor symptoms but motor symptoms as wells.

Reference:

Chen YL et al., [Parkinson's disease combined with overactive bladder syndrome treated with acupuncture and medication]. Zhongguo Zhen Jiu. 2012 Mar;32(3):215-8.     http://www.ncbi.nlm.nih.gov/pubmed/22471132

Acupuncture technique, Qin’s eight scalp needles helps relieve symptoms of Parkinson’s disease

Qin’s eight scalp needles, another acupuncture technique is reported improved both motor and non-motor symptoms of Parkinson’s, in the journal Zhonggou Zhen Jiu (Chinese Acupuncture & Moxibustion).

The term, the eight scalp needles, has been developed by Professor Qin Liang-Fu. It includes bilateral GB8 (Shuaigu), GB15 (Toulinqi) and GB20 (Fengchi), as well as Baihui (GV20) and Yintang (Ext2). Based on his years of clinical experience, he observed the importance of Governor Vessel meridian for limb disorders and miscellaneous diseases and that the similarity between the cephalic motor region distribution and relevant scalp acupoints of many meridians. Professor Qin then proposed the eight scalp needles which, in combination with different body acupoints, has been shown effectively in treating neurodegenerative disorders such as Parkinson’ and multiple sclerosis.

Qin’s eight scalp needles in combination with other body acupoints has been show improving tremor, rigidity, slow movement, anxiety and depression, and enhanced memory function, sleep quality and decreased UPDRS scores in Parkinson’s patients.

Qin’ eight scalp needles and “the seven acupoint of cranial base” reported here before show the diversity of acupuncture techniques used to treat Parkinson’s in China.

Reference:

Dong J & Cui HS, Clinical experience of Qin’s eight scalp needles for treatment of Parkinson’s disease. Zhongguo Zhen Jiu. 2014 May;34(5):491-4.    http://www.ncbi.nlm.nih.gov/pubmed/25022128

Progress in early diagnosis of Parkinson’s disease

Early diagnosis of Parkinson’s disease is crucial to effectively slow down the progression of condition. A study, reporting that 181 genes in the blood showed a similar expression trend both in Parkinson’s patients and normal subjects, was published in Journal Biomedical and Environmental Sciences.

So far Parkinson’s can be diagnosed according to medical history and neurological symptoms. At this stage, majority of dopamine cells in the brain have already degenerated. How to diagnose the condition at the possible early stage is very important to slow down the progression of neurodegeneration in Parkinson’s.

Scientists in China recently analysed gene expression profiles of Parkinson’s in blood in order to find candidate genes in the blood for its early diagnosis. Using high-throughput cell biology techniques they analysed blood sample from 27 patients with PD and 26 control subjects and found that 181 genes in blood exhibited the similar expression profile trend within PD patients and control subjects. Those genes possess important biological process function and can be potential candidates of serum markers for early diagnosis of Parkinson’s.

The findings of study are promising for the early diagnosis of Parkinson’s. In the future, when the biomarkers can reliably indicate the early symptoms of Parkinson’s early acupuncture treatment to patients may be able to stop or slow down the disease progression, as suggested by the reports of basic and clinic acupuncture studies.

Reference:

Zhang Y et al., Bioinformatics Analysis Raises Candidate Genes in Blood for Early Screening of Parkinson’s Disease. Biomed Environ Sci, 2014; 27(6): 462-465.  http://www.ncbi.nlm.nih.gov/pubmed/24961856

Acupuncture improves PD symptoms and helps Parkinson’s patients gradually stop medication.

An acupuncture technique called “the seven acupoints of the cranial base” is reported to improve clinical symptoms of Parkinson’s disease (PD) and help Parkinson’s patients gradually stopped medications for two weeks after acupuncture treatment. It was published in journal Chinese Acupuncture & Moxibustion recently.

The seven acupoints of cranial base consists of DU15, bilateral BL10, GB20 and GB12 and is located at the very place of cranial bottom. It is believed that the function pattern of the seven acupoints echoes the brain resting-state network.

Researchers in China conducted the clinical study to assess the effectiveness of the seven acupoints of the cranial base in patients with Parkinson’s. Forty nine patients with Parkinson’s were assessed using Webster scores and categorized as early illness (<10 scores, n=4), moderate (11-20 scores, n=43) and advanced (21-25 scores, n=2). Before acupuncture 36 patients were treated with Madopar other patients were given other medications. All patients were given electroacupuncture at the seven acupoints for 30min, 3 times a week.

Patients with early stage of PD stopped taking medication after 3 times of acupuncture, but continued acupuncture treatment for a further 6 times. Patients with moderate PD reduced their medication to half dosage after having 3-time acupuncture, and stopped taking medication after 6^th acupuncture, but continued acupuncture treatment for a further 6 times. Advanced patients reduced their medication by a third after 3-time acupuncture, and reduced their medication to half dosage after 6^th acupuncture treatment, then stopped medication after 10^th acupuncture, but continued acupuncture treatment for a further 9 times. There was no adverse effect and complication during and after acupuncture treatment.

Before acupuncture the average of Webster scores was 16.74±3.35 and it was significantly reduced to 11.50±4.17 after acupuncture treatment. Approximately 87% of patients with PD stopped medication for two weeks after last acupuncture treatment and maintained good improvement of their symptoms.

It will be interesting to know the outcome of the follow-up study.

Reference:

Yuan Y et al., [Forty-nine cases of Parkinson's disease treated by acupuncture adjunctive therapy]. Zhongguo Zhen Jiu. 2014 Jan;34(1):53-4. Chinese. 

Acupuncture improves certain aspects of motor symptoms in Parkinson’s disease

Electroacupuncture improved gait, balance and postural transitions in patients with Parkinson’s, suggests in a study published in journal Neurology.

Gait and balance disturbance, and postural instability are parts of motor dysfunction of Parkinson’s. They are predicators of falling risk and impaired quality of life and have emerged as major therapeutic concerns in Parkinson’s treatment.

In a pilot study, researchers in Arizona, the United States, using objective modalities based on innovative body worn sensors technology, assessed the effect of acupuncture on gait and balance in Parkinson’s patients. Eight patients with Parkinson’s were treated with electroacupuncture once a week for three weeks. Outcomes assessed at baseline prior to and at the end of the treatment. Measurements include many aspects of gait, balance and quality of life. At the end of treatment gait, balance and postural transitions were all markedly improved in acupuncture group compared to control group. Further, improvement in gait, balance and postural transitions in acupuncture group were significantly better compared to the pre-treatment scores, while there is no change in control group compared to baseline.

Authors conclude that electroacupuncture is an effective treatment in improving certain aspects of motor symptoms of Parkinson’s.

Reference:

Lei H et al., Objective Assessment of Electro-acupuncture Benefit for Improving Balance and Gait in Patients with Parkinson’s Disease (P3.074). Neurology April 8, 2014 vol. 82 no. 10 Supplement P3.074.    http://www.neurology.org/content/82/10_Supplement/P3.074

Acupuncture and levodopa in combination enhanced the benefits of levodopa and reduced levodopa-induced dyskinesia

Combined acupuncture and levodopa greatly enhanced motor functions of levodopa treatment and reduced levodopa-induced side effects such as dyskinesia in a Parkinson’s model, according to a study recently published in journal Brain Research.

Levodopa is the most effective drug for alleviating motor symptoms of Parkinson’s. However, more than 50% of PD patients treated with levodopa develop adverse effects such as dyskinesia, hallucination, insomnia. Among these, levodopa-induced dyskinesia is the most debilitating and severe side effect and in many cases worsen than PD symptoms. This has a great impact on the quality of life of patients with PD.

Researchers in Korea investigated whether combination of acupuncture and levodopa improves motor function in PD mice model and simultaneously alleviates dyskinesia. In combined group PD mice were treated with acupuncture at acupoint GB34 and levodopa (7.5mg/kg). In levodopa alone group PD mice was treated with standard dose of levodopa (15mg/kg). PD mice in control group were given non-acupoint treatment. Acupuncture was given once a day for 7 days. Behavioural results showed that PD mice in combined group displayed motor function improvement that was comparable to that of levodopa (15mg/kg) alone group, and the combined group significantly reduced levodopa-induced dyskinesia. Biochemical study found that the combination treatment significantly reduced abnormally elevated brain chemicals that are closely linked with motor function and occurrence of dyskinesia.

This study suggests that acupuncture can be used as an adjunct with levodopa to enhance the efficacy of levodopa and reduce the adverse effects in treatment of Parkinson’s.

Reference:

Kim SN et al., Combined treatment with acupuncture reduces effective dose and alleviates adverse effect of L-dopa by normalizing Parkinson's disease-induced neurochemical imbalance. Brain Res. 2014 Jan 28;1544:33-44.   http://www.ncbi.nlm.nih.gov/pubmed/24321617  

Scalp acupuncture increased dopamine release in the striatum of Parkinson’s disease models

Although scalp acupuncture is relatively new compared with body acupuncture it has been used to effectively treat neurological disorders such as stroke. Scalp acupuncture not only accelerated the functional recovery, also alleviated many post-stroke complications alone or in combination with rehabilitation training courses.

Scalp acupuncture has gained increasingly attention in Parkinson’s disease (PD) research and treatment. Scalp acupuncture studies in PD models reported that scalp acupuncture stimulation modulated expression of many biomarkers in favour of survival of dopaminergic neuron in brain. For example, scalp acupuncture increased release of neurotrophic factor; inhibited apoptotic cell death process, protected dopaminergic neurons against toxin insults. This led to the increased release of dopamine in the striatum, the important movement regulatory centre in the brain, leading to better functional recovery.

Although studies of body acupuncture also reported its neuroprotection in PD models it did not increase dopamine content in the striatum. It is conceivable that combination of scalp acupuncture and body acupuncture should increase neuroprotection and dopamine levels in the brain. This will improve the efficacy of acupuncture treatment in Parkinson’s disease.

Reference:

Wang S et al., Study on the mechanism of electroacupuncture scalp point penetration therapy in action on apoptosis in the Parkinson's disease rat model. Zhongguo Zhen Jiu. 2009 Apr;29(4):309-13.  http://www.ncbi.nlm.nih.gov/pubmed/19565741

Acupuncture therapy for non-motor symptoms of Parkinson’s disease

Non-motor symptoms (NMS) of Parkinson’s disease (PD) are common but often are not well recognized in clinic practice due to the lack of spontaneous complaints from patients and of effective procedures of identification. NMS occurs throughout the course of the disease. Some of them, such as depression, fatigue and smelling dysfunction, may appear at the earliest stage of the disease in not treated patients. Others appear at the advanced stage of the disease. At the time of diagnosis, the prevalence of NMS among PD patients is 21% (pain, urinary symptoms, depression and anxiety) and goes up to 88% after 7 years disease progression. NMS of PD ranges from autonomic dysfunction, neuropsychiatric disorders, sleep disturbance to gastrointestinal syndromes and many others and are under-treated. Indeed, non-motor aspects of PD have greater influence on quality of life and institutionalization rates, and healthcare cost. In general NMS of PD respond poorly if at all to dopaminergic treatment, indicating the involvement of other neurotransmitters besides the dopamine.

Acupuncture including manual and electroacupuncture is effective in treat both motor symptoms and non-motor symptoms of PD. Studies about the mechanisms of acupuncture reported that acupuncture stimulation modulates the expression of neurotransmitters such as serotonin, glutamate and gammaaminobutyric acid etc in the brain.  Available clinic studies showed that acupuncture therapy significantly improves NMS such as depression, anxiety, insomnia, pain, orthostasis, constipation, fatigue and vomiting, leading to the improvement of quality of life in PD patients.

Reference:

Cristian A et al., Evaluation of acupuncture in the treatment of Parkinson’s disease: a double-blind pilot study. Movement Disorders, 2005, Vol. 20:1185-1188.
http://www.ncbi.nlm.nih.gov/pubmed/?term=cristian+a%2C+acupuncture

Acupuncture enhanced anti-parkinsonian effect of levodopa in patients with Parkinson's disease

Since its introduction in the 1970s, levodopa has remained the most effective treatment for the motor symptoms of PD. However, as PD patients receive chronic treatment with levodopa they gradually develop two main clinical phenomena: fluctuation in motor response and a variety of involuntary movements, known as levodopa-induced dyskinesia. The frequency of these motor complications has been estimated between 40-60%, after approximately 5 years of levodopa medication, but increase to 90% after 10 years of treatment.  Those adverse effects of levodopa medication are often disturbing and have huge impact on quality of life of PD patients. In China, combination of acupuncture and levodopa is often used to treat patients with PD. Many clinical studies reported that combined treatment had better therapeutic effects than levodopa treatment alone. The combined treatment showed prolonged and better alleviation of motor symptoms. 

Reference:

Chang XH et al., Observation on therapeutic effect of acupuncture combined with medicine on Parkinson disease. Zhongguo Zhen Jiu. 2008 Sep;28(9):645-7.   http://www.ncbi.nlm.nih.gov/pubmed/18822978

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