Brief Answer:
Vitamins and other nutritional angles to treat PD

Detailed Answer:
Good afternoon. Thank you for your question. Your question is one that has been asked through the ages but to date has yet to be answered entirely satisfactorily in the sense that a cure or universal suggestion that can even make all people significantly improved. Here's how I approach my patients who are referred to me either with tremor who appear parkinsonian or those who are referred to me with a presumptive diagnosis of Parkinson's disease.

First and foremost I VERIFY the diagnosis to be sure that there is not another process going on that may give the APPEARANCE of PD but is really not. There are several such processes. Once I've verified the diagnosis then, comes the strategy to treat. In your case, age 56 is slightly on the early side of things therefore, I clearly would see that the patient was involved in as robust exercise program as possible. Exercise...not just of the involved tremulous hand but of the entire body has been shown to have a positive effect on the rejuvenation....even regeneration of microstructural elements between nerves and muscles which tend to atrophy and die off due to DISUSE...which seems to be on the basis of increasing immobility of the patient based upon loss of dopamine from the brain.

It is true that we believe the primordial problem in PD is the loss of neurons from the brain that ultimately manufacture the key ingredient to good and normal movements...DOPAMINE....It is also true that we have a poor understanding of how the process begins or what signals these neurons to start shutting down. Nobody knows. But what exercise physiologists and rehab specialists have shown through rather elegantly designed protocols is that neuromuscular contacts of a nerve which are actually much denser than ever before believed can be stimulated by the mere act of regular and persistent exercise.

This "resprouting" if you will is independent of the attrition going on in the brain of the dopamine producing neurons although there is obviously a link between the amount and quality of exercise one does and degree of damage or destruction to these neurons that have occurred. When in the early stages, however, I've found that it is quite possible to get younger patients who are not terribly debilitated or immobile to have the best chance of rejuvenating their connections by engaging in such exercise. The more microstructural connections one can "sprout" from their motor nerves to muscles in question the more stabilized and efficient contractions can be.....and it is felt to be these good strong and frequent contractions on axial musculature that actually FEEDS BACK or REPORTS back to the brain on its activity which then, somehow produces NATURAL ELECTRICAL STIMULATION to the dopamine producing neurons that could have a slowing down....(don't know about reversing) effect. This is the some type of theory under which Deep Brain Stimulation (DBS) operates.

Standard/conventional treatments to address tremor include, as you know, carbidopa/levodopa...however, because you are so young.....I might suggest that you speak with your doctors (neurologist preferred) about using DOPAMINE AGONISTS such as pramipexole and ropinirole as a way of saving the use of levodopa for later when you may need more robust medication effects. And then, there are things such as COMTAN which can extend the life of the dopamine in your system by blocking its breakdown...or rasigiline which has been said to RETARD the attrition rate of the dopamine neurons.

I've seen very limited results with rasagiline, somewhat better results with COMTAN, and mediocre to acceptable results with combinations of the dopamine agonists.

I've not seen measurable results either by physician or patient using the standard vitamins/nutritional supplements such as CoQ, B12, or Vit. D although I always recommend that levels always be optimized and maintained....(you wouldn't want to run your car engine with only 3/4 full oil or water just because it will still run, right?)....in the same light you should always look to OPTIMIZE your body fluids and chemicals/vitamins/minerals to get best results while treating any disease process.

BUT...and here is the one thing I have seen results in about 50% of patients treated in the my own clinics AND there are scientific data backing up the results though there is no FDA approval at this point for the medication.....it is NAD infusion therapy. It is also comes in a tablet form.....but where I've seen the most robust effect is in infusion form. It's a bit costly....so it may not be for everyone just from that perspective and it's done in limited fashion around the country here in the U.S. as well as Europe because people are just not aware of its potential....but Nicotinamide Adenine Dinucleotide (NAD+) has reduced tremor by at least 20-30% in patients I've treated in clinic. We do 6 day protocol infusions and usually see results within the first few days of treatment. Monthly infusions are recommended to sustain the effects (unfortunately....but not surprising since the substance itself is naturally produced in the body and therefore metabolized) but I've seen patients go a couple of months before the tremor or other features of their PD come back and then, they get another series of infusions.

Again, this is unfortunately, a costly treatment and I think very few insurance companies would pick up the tab because it is not FDA approved but it is something worth looking into because of clinical data that have been accumulated on its use (going on 20-30 years in Europe).....less in the U.S. but major medical centers are beginning to see this as an option in their PD patients who don't respond to anything else. My opinion is that it should be a first line drug IN CONJUNCTION with other standards of therapy.

I will provide you the link to the clinic in my area that has the clinical studies on its website as it relates to its role in PD. NAD is used for several other medical treatments.

http://www.lunaliving.org/research-and-resources/


If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 39 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---