Parkinson's Disease Department of Neurology The University of Chicago Medical Center Hospitals



Conventional medications are the current standard of care and have been well studied with large scale, controlled trials. However, there are alternative therapies that are of interest. Unfortunately, large scale controlled trials have not been performed for alternative approaches. Thus it is difficult to comment on the safety or efficacy of these medications. For example, chelation therapy and IV glutathione are available as alternative therapies but have not been studied according to strict scientific methods.

Vitamins and Other Supplements
One mechanism by which the disease progresses may be due to oxidative stress. As dopamine is metabolized in the brain, oxygen radicals are created which can then further damage dopamine producing cells accelerating progression of the disease. Reducing oxidative stress by using vitamins and other antioxidants may be helpful. Recent studies show that Vitamin E and Coenzyme Q-10 show a trend towards reducing risk of PD or slowing disease progression. However, the exact dosages that are likely to be effective have yet to be determined. Large-scale clinical trails are required to confirm these trends.

Patients should discuss use of herbal supplements with a physician before taking them. For example, St. John's Wort, an herbal remedy promoted as a treatment for mild depression, can have harmful interactions with some other medications. Because the mechanism of action is still unclear it is best to avoid St. John's Wort when taking medications for Parkinson's disease that block the monamine oxidase system such as selegeline (Eldepryl).

Exercise and PD
One of the best ways to cope with PD is to incorporate a regimen of regular exercise into the daily routine. Exercises that promote stretching, range of motion and relaxation techniques such as yoga and tai chi may be especially useful. Walking and swimming are also very helpful.

Physical Therapy, Occupational Therapy and Speech Therapy
Physical therapy can help with gait and balance. It can also reduce the risk of frozen-shoulder that may occur in PD as a result of diminished arm swing. Occupational therapy can help devise coping mechanisms appropriate for each stage of the disease. Speech therapy can improve soft or slurred speech to some extent.

Nutrition and Diet
There are no specific dietary recommendations for PD. A well-balanced diet is an important part of maintaining good health. In some patients dietary protein intake may reduce the effectiveness of levodopa. Ensuring that the drug is not taken too close to mealtimes, taking most of the daily protein toward the end of the day, and a low-protein diet are some strategies that are helpful. A low-protein diet should only be carried out under medical supervision.