Parkinson’s disease: Prevention, Ayurvedic Treatment, Remedies

Article by Dr Raghuram Y.S. MD (Ay)
Our daily living depends on how we move around and effectively accomplish our activities. We cannot imagine the progression of our lives if our hands and legs are not functional or reservedly functioning. What if some disorder is making your hands to shake unnecessarily or making your limbs tight and rigid restricting your coordinated activities, makes your movement slower than normal or makes your walking around difficult? You feel yourself helpless and the mechanics and dynamics of your life seems to come to a halt!!

Parkinson’s disease or Parkinsonism is one such disease which disturbs your activities of daily living by limiting your movements or altering your movements in a way which you would not have preferred to have.

Parkinson’s disease (PD) is called as Kampa Vata in Ayurveda. It is also called by other names like Vepana, Vepathu, Spandhana, Sphurana etc in various contexts. The meaning of all the terms is the same – ‘exaggerated movements of the limbs’

What is Parkinson’s disease?

Parkinsons disease is a progressive disease of the nervous system. It gradually develops with a barely noticeable tremor in just one hand. The disease presents with Tremor, stiffness and slowing of movements. Symptoms worsen as the condition progresses with time.

In the early stages of PD, you may notice –
That your face has little or no expression
That your arms do not swing when you walk
That your voice has softened or slurred

Other names:
Idiopathic Primary Parkinsonism
Hypokinetic Rigid Syndrome
Paralysis Agitans

It is a degenerative disorder of the central nervous system. It mainly affects the motor system. It happens due to the death of some cells located in a region of mid-brain (substantia nigra) which generate a chemical called dopamine. It is not clear regarding what causes cell death.

Symptoms

Early symptoms –
Shaking
Rigidity
Slowness of movement
Difficulty with walking and gait

Later symptoms –
Disturbance of thinking and behaviour, mainly Dementia
Psychiatric, like Depression
Sensory problems
Sleep related problems
Emotional problems

Diet and Vitamins

Healthy eating:
We can’t find any particular food combinations which can help recover from Parkinson’s disease. Some foods definitely help in easing some symptoms. High fibre foods and lot of fluids will keep the gut healthy; they help in preventing constipation which is common in PD. Balance provides good nutrition.

Supplements of Vitamin E – Vitamin E is considered to be an alternative treatment for Parkinson’s. 900-1200 IU vitamin E taken every day can soothe some of the symptoms of Parkinson’s disease. Vitamin E is a good antioxidant and hence may be useful in Parkinson’s disease. It can aid in the protection of the brain which in turn will reduce the effects of Parkinson’s.

Consumption of more vitamin B12 would help people battling Parkinson’s. It is abundantly found in animal protein. For vegetarians, it can be found in fortified cereals. Eating foods that are rich in antioxidants such as berries, beans, potatoes, apples, fish etc can help.

Foods with high concentration of omega3 fatty acids such as salmon, flax seeds, sardines, walnuts etc would help.

Antioxidants – The most promising approach appears to be the use of antioxidants in the treatment of Parkinson’s disease, to slow down the oxidation and damage to the substantia nigra. The best example is Amalaki or Emblica officinalis (Indian gooseberry).

Some research works have shown that caffeine (greater intake of caffeinated beverages like coffee) may reduce the risk of Parkinsonism

Green tea also may reduce the risk of developing PD. Research by Baolu Zhao specifically indicates green tea’s polyphenol’s protect dopamine neurons. In a similar study at Seoul National University College of Medicine found that EGCG, the neuro-protective agent in green tea slashed the neuronal death by half when administered to mice.

Research has shown that people who eat more fruits and vegetables, high-fibre foods, fish, omega-3 rich oils (Mediterranean diet) and who eat less red meat and dairy may have some protection against Parkinson’s disease.

Tobacco may reduce the risk of PD by a third when compared to non-smokers (nicotine might act as a dopamine stimulant, compounds like MAO inhibitors present in tobacco smoke might contribute to this effect)
Antioxidants such as vitamins C and D are protective against the disease (results of studies are contradictory, no positive effect proved)
Fats and fatty acids are said to be protective (risk-increasing effects or no effects also have been shown)
Estrogens and anti-inflammatory drugs have a possible protective role. Research

Turmeric:
Turmeric is yet another Ayurvedic drug and an essential part of Indian kitchen. Michigan State University researcher Basir Ahmad led a team of researchers who found that Curcumin, a compound of turmeric, may help fight Parkinson’s disease by disrupting proteins responsible for the disease and preventing said proteins from aggregating. Source

Alternate medicines which help in Parkinson’s disease –
Medical Supplement of Coenzyme Q10 – Coenzyme Q10 is a substance that is found lacking among people who have Parkinson’s disease. So its medical supplement might help in PD according to some established studies. A study conducted in UCSD tested the effects of supplements of Coenzyme Q10 on animal brains. It was found that it does protect the part of the brain that is affected during PD. Several other studies conducted at Cornell University and NINDS also show the same.
High doses of this coenzyme (readily available supplement) has proved to help in some cases of PD after prolonged use (more than 16 months).

Other useful medicines tried are –
N-acetyl cysteine, Quercetin,
Selenium (normally found in multivitamin and mineral pills, antioxidant, and increase’s glutathione levels),
Melatonin (sleep hormone with antioxidant abilities),
Ashwagandha (Withania somnifera),
L-dopa (immediate precursor of dopamine) often combined with carbidopa,
Kapikachchu (Mucuna pruriens, antioxidant and dopamine provider),
Tyrosine (amino acid that can be converted into L-dopa),
NADH (regenerates glutathione)

MAO Inhibitors (MAOI) – Dopamine is broken down in the brain by an enzyme called Monoamine oxidase (MAO). When the activity of MAO is inhibited, dopamine stays around longer and this benefits those with PD. The drugs which do this are called MAOI’s, Ex. Selegiline

The below mentioned nutrients may not be directly involved in making dopamine but could improve general cognitive abilities or provide other benefits. They are –
Fish oils
Ginko biloba (40mg dosage with breakfast or lunch) has antioxidant properties and helps improve memory and alertness
Curcumin (strong antioxidant)
Calcium and Vitamin D supplements help for bone health as PD patients have an elevated risk of developing fragile bones and fractures.

Massage – Massage therapy reduces muscle tension and promote relaxation
Acupuncture – may help reducing pains
Tai Chi – is an ancient Chinese exercise, helps improve flexibility, balance and muscle strength. It may also help prevent falls.
Yoga – gentle stretching movements and poses may increase your flexibility and balance
Alexander technique – focuses on muscle posture, balance and thinking about how you use muscles, may reduce muscle tension and pain
Meditation – may reduce stress and pain and improve your sense of well being
Music or art therapy – Music helps in improving walking and speech, Art therapies like painting and ceramics improve your mood and help you relax
Pet therapy – Having a dog or cat may increase your flexibility and movement and prove your emotional health

Yoga for Parkinson’s disease

The below mentioned Yoga asanas are the best for those suffering from Parkinson’s disease:
Tadasana – The Mountain pose

Tadasana (Mountain Pose) to Urdhwa Hastasana (Upward salute or upward hand pose)

Uttanasana (Standing forward bend pose)

Virabhadrasana II (Warrior pose II)

Jathara parivarthasana (Abdominal twist) – There are a few variants of this asana. You can follow that which seems to be easier to you. Below given are the videos of the variants of Abdominal twist pose.

Supta Baddha Konasana (Reclining bound angle pose)

Home treatment

Home treatment for PD:
Home treatments may be helpful early on in Parkinson’s disease when the disease has not disrupted your life or after having got substantial relief following treatment for the same.
Modify your activities and your home – Simplify your day to day activities. Change the location of your furniture’s so that you can hold on to something as you move around in the house.
Eat healthy foods – Use plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, low fat dairy products
Take good exercise and physical therapy. They have good benefits at all stages of the disease when done on a regular basis
Dealing with tremor – Put some weight on your hand, it will help in reducing tremor and restore control

For tremors – Take medicines consistently and on time. Restrict your protein intake as dietary proteins (to approximately 12% of daily calories) can limit your body’s absorption of Levodopa. To do this you need to take the opinion of a nutritionist. Also carefully read food labels. Fruits and vegetables might protect nerve cell function and possibly keep PD symptoms under control if taken in bulk and wisely.

Improving speech quality – by working with a speech-language therapist
Reduce problems with eating and drooling – by changing what and how you eat
Deal with freezing – stepping toward a specific target on the ground etc
Dealing with sexual function problems – by talking with your doctor
Dealing with depression – talk to your friend or family member or doctor when you feel sad or depressed
Dealing with dementia – talk to your doctor if you have memory loss, confusions, trouble thinking clearly etc. Source

Safety changes at home –
Small changes at home can make big differences for Parkinson’s disease patients. This can be done by discussing specific strategies with your doctor, health care provider or occupational therapists. These people can provide you to look at the things like furniture placements, handrails and extensions on toilets, and floor coverings to determine where possible hazard’s lie and how to make your home easier to navigate.

Home remedies

Natural home remedies for Parkinson’s disease:
Since Parkinson’s disease is a non-curable disease, trying home remedies might not work out as single hand remedies. They will come handy when used alongside the treatment protocol of PD including medicines, lifestyle corrections, treatments and diet. Some home remedies which can be useful in PD are:

Brahmi (Bacopa monneiri):
It is an Ayurvedic herb. It is used in USA as water plants in aquariums. It has been used in memory related disorders for centuries in India. Now days it is frequently prescribed by many practitioners. According to study in University of Maryland Medical Centre, Brahmi has proved to improve circulation to the brain and even protect brain cells. Another study by Pennsylvania State University College of Medicine applied Brahmi seed powder to rodent models of Parkinson’s. Results showed promise in conquering the disease and protecting the brain from damage.

Cowhage – Kapikacchu
Kapikachu (Mucuna pruriens – Cowhage) is the best in business of tackling PD. It has been in Ayurvedic practice since ages. University of Maryland Medical Centre speculated that cowhage which contains Levodopa or L-dopa might perform better than L-dopa administered as a drug against Parkinson’s disease.

Gingko Biloba:
It is a beneficial herb for PD sufferers. In a 2012 study at the National Institute of Neurology and Neurosurgery in Mexico, a patented extract of gingko leaves were dispensed to animal models of Parkinson’s. the extract showed neuro-protective and neuro-recovery effects against midbrain dopamine neuron damage and even damage to locomotion. Researchers declared ‘these studies suggest it as an alternative in the future treatment of PD’. Related.

Glutathione antioxidants –
Fruits and vegetables containing glutathione or foods which help in its production are helpful in Parkinson’s disease. Ex. asparagus, spinach, broccoli, cauliflower, cabbage, garlic, onions, tomatoes, avocado, squash, potatoes, melons, grapefruit, strawberries and peaches etc contain glutathione. Glutathione is called ‘the master antioxidant’.

Fresh, raw milk and raw eggs promote glutathione production. Similarly red meats, desiccated liver and organ meats from grass-fed animals contain alpha lipoic acid which helps them to regenerate glutathione and support sustained activity of vitamins C and E in the body.
Curcumin present in Turmeric, apart from being an antioxidant and antiseptic, enhances glutathione metabolism.
Nondenatured native whey protein contains good levels of glutathione.
Chronic stress depletes glutathione. Therefore handling stress is the key in maintaining its metabolism and preventing or treating PD. Good exercise also boosts up glutathione metabolism

R-alpha lipoic acid – 10-50mg a few times a week in the morning with breakfast is useful in Parkinson’s disease. It is a powerful antioxidant and helps generate glutathione. It may be used in combination with Acetyl-I-Carnitine as a treatment in PD. This combination exerts efficient preventive effect in PD.

CoQ10 helps preserve dopaminergic neurons from toxins. It also improves energy production in cells.

Natural vitamin E complex – 30-200 units, a few times a week is protective against PD. Foods rich in the vitamin are nuts, seeds, wheat germ, spinach and other green leafy vegetables.

Natural Vitamin C with bioflavonoids (100-300mg once or twice daily) – is not only a powerful antioxidant but also helps in production of L-dopa from tyrosine. Amla or Indian gooseberry is the riches source of natural vitamin C.

Vitamin D (about 1,000 units a day)

Alternate treatment’s for PD:
Alternate treatment includes dietary changes, exercises, massage, Ayurveda, aromatherapy, Yoga, chiropractic treatment, hypnosis etc.

Acupuncture:
Needle based therapy that originated in China. It can help reduce symptoms of Parkinson’s disease in a person. Symptoms and effects of Parkinson’s such as sleeplessness, dementia and depression are reduced with acupuncture. It is a deep brain stimulation treatment. Brain stimulation will help in correcting cognitive and motor effects of PD. It can have a positive effect on the motor coordination, muscular spasms, cramps, tremor, rigidity etc felt by PD patients.

Tai Chi – Chinese martial art. It uses slow rhythmic movement of the body. Regular practice of Tai Chi techniques could be a potential alternative for Parkinson’s. It connects mind and body and is said to reduce mental and physical symptoms of Parkinson’s disease. Some motor coordination troubles related to the disease are corrected. A study done by Fuzhong Li in the England Journal of Medicine shows that Tai Chi can help alleviate stress and allows better control over movement. UCLA Psychiatrist Michael Irwin is of the opinion that Tai Chi could retrain certain parts of the brain through guided meditation which is how it acts as one of the alternative treatments of Parkinson’s.

Exercises for Parkinson’s Disease treatment:
Some research has shown that regular aerobic exercise may reduce the risk of PD (exercise has more impact on PD in middle aged people)

Exercises increase the muscle strength, flexibility and balance. They will help in keeping up good health and to reduce depression and or anxiety. There are different exercises which fit into comfort zone of different people. Doctors or physical therapists can help you in scheming out an exercise program which suits you. Exercises such as walking, swimming, gardening, dancing, water aerobics or stretching are highly recommended.
Difficulty in walking with a normal gait is common in Parkinson’s disease as the disease disturbs your sense of balance. Exercises help in improving the balance.

While walking or moving around…
Don’t move too quickly
See that your heel strikes the floor first when you are walking
Stop and check your posture if you notice yourself shuffling. It is preferable to stand up straight
Look forward and not downward while walking

Avoiding falls:
Falling down is common in the later stages of the disease. You may be thrown off balance just by a small push or bump. Follow the below said suggestions –
Make a U-turn instead of pivoting your body over your feet
Distribute your weight evenly between both feet and do not lean
Avoid carrying things while walking
Avoid walking backwards

Daily living activities:
Daily living activities like dressing, eating, bathing and writing becomes difficult in PD. An occupational therapist will help you in coping up with these activities and help you to make daily life easier.

Regular exercise helps relieving muscle stiffness. In Parkinson’s disease, exercise is considered to be a possible intervention and possible neuro-protective measure. The below mentioned stretching and flexibility exercises help to relieve stiff muscles, improve flexibility and make daily activities easier –

  1. Stand facing the wall at a distance of about 8 inches. Reach your arms upward. Next place your hands on the wall for balance. Stretch out your arms and back.
    Place your back against the wall for support. Then briskly march in place, lifting your knees as high as possible.
  2. Sit in a chair with a high, straight back and stretch your arms behind the chair bringing your shoulders back as far as you can. As you stretch, lift your head toward the ceiling.
  3. Sit in a chair. Stomp your feet up and down while pumping your arms back and forth at your sides.
  4. Gait training at home can help in improving walking disabilities and help in balancing. This involves new ways to stand, walk and turn.
    Take large steps when walking straight ahead. Focus on proper heel-toe form.
    Keep the legs at least 10 inches apart while turning or walking in order to provide more support and reduce risk of falls.
    Avoid shoes with rubber soles. These shoes tend to stick to the floor and increase risk of falls.
    Walk to a steady rhythm. Practice this type of gait training with the help of a metronome – a tool the musician’s use to make and keep a rhythmic beat.

Parkinson’s disease modern perspective

Review of Parkinson’s disease – a modern perspective –

Causes:
In most people Parkinson’s disease is idiopathic (having no specific known cause)

We can find a genetic factor in a small proportion of cases
Environmental factors:
Pesticide exposure
Head injuries
Living in the country
Farming
Rural environments and drinking well water (indirect methods of exposure to pesticides)
Heavy metal exposure (their possible accumulation in substantia nigra of brain)

Genetics –
Generally Parkinson’s disease is considered to be a non-genetic disorder
Around 15% of individuals with PD have a 1st degree relative who has the disease
5% (approximately) people are known to have Parkinson’s disease that occur because of a mutation of one of several specific genes. The most extensively studied PD-related genes are SNCA and LRRK2.
Several Parkinson-related genes are involved in the function of lysosomes, organelles that digest cellular waste products. Some forms of Parkinson’s disease may be caused by lysosome dysfunctions that reduce the ability of the cells to break down alpha-synuclein.

Parkinsons disease pathology

Pathology

Anatomical –
Basal ganglia are a group of brain structures. They are innervated by the dopaminergic system. These areas are highly affected in Parkinson’s disease.
The main pathological characteristic of Parkinson’s disease is cell death in the substantia nigra and more specifically, the ventral (front) part of the pars compacta affecting up to 70% of the cells by the time death occurs.
Macroscopic – Reduction of neuromelanin pigmentation in the substantia nigra and locus coeruleus suggests neuronal loss on cut surfaces of brainstem
Microscopic (histopathology) – Neuronal loss in substantia nigra and several other brain regions and Lewy Bodies in many of the remaining nerve cells
Neuronal loss is accompanied by death of astrocytes (star shaped glial cells) and activation of the microglia (another type of glial cell)
Lewy bodies are a key pathological feature of Parkinson’s disease

Pathophysiology

Cell death in the pars compacta region of the substantia nigra leads to greatly reduced activity of dopamine-secreting cells. This leads to the manifestation of primary symptoms of Parkinson’s disease.

Motor, oculo-motor, associative, limbic and orbito-frontal circuits are the 5 major pathways in the brain connecting other brain areas with basal ganglia. All of them are affected in Parkinson’s disease. These circuits are involved in a wide variety of functions including movement, attention and learning. The disruption of these circuits leads to many symptoms related to disturbance of the mentioned functions.

The basal ganglia normally exert a constant inhibitory influence on a wide range of motor systems preventing them from becoming active at inappropriate times. When a decision is made to perform a particular action, inhibition is reduced for the required motor system, thereby releasing it for activation. Dopamine acts to facilitate this release of inhibition. High levels of dopamine function tend to promote motor activity, while low levels of dopamine function, such as that which occurs in Parkinson’s disease, demands greater exertions of effort for any given movement. . Thus the net effect of dopamine depletion is to produce hypokinesia, an overall reduction in motor output. Drugs used to treat Parkinson’s disease may produce excessive dopamine activity, allowing motor systems to be activated at inappropriate times and thereby producing dyskinesias

Brain cell death –
Abnormal accumulation of the protein alpha-synuclein (protein abundant in human brain) bound to ubiquitin (regulatory protein found in almost all tissues). This insoluble protein accumulates inside neurones forming inclusions of Lewy bodies.
Lewy bodies first appear in the olfactory bulb, medulla oblongata and pontine tegmentum. Individuals at this stage are asymptomatic.
As the disease progresses, the Lewy bodies later develop in substantia nigra areas of mid-brain and basal forebrain, and in a last step the neocortex.
These brain sites are the main places of neuronal degeneration in PD
Lewy bodies may not cause cell death and they may be protective.
In people with dementia, a generalized presence of Lewy bodies is common in cortical areas.

Other cell-death mechanisims include –
Dysfunction of proteosomal system
Dysfunction of lysosomal system
Reduced mitochondrial activity
Iron accumulation in substantia nigra is observed in conjunction with protein inclusions
Oxidative stress
Protein aggregation
Neuronal death

Classification

Classification of Parkinson’s disease –
Parkinsonism or Parkinsonian Syndrome is a term used to describe the collective motor symptoms of PD. The main symptoms of the motor syndrome are tremors at rest, stiffness, slowing of movement and postural instability.

Parkinsonian syndrome may be divided into 4 subtypes according to their origin. They are as described below –
Primary or idiopathic Parkinsonism:
It is the name given for Parkinson’s disease which is the most common form of Parkinsonism
This type of Parkinsonism does not have any external identifiable cause
Genetic Parkinson’s disease’s with a similar clinical course to PD are generally included under this type.

Secondary or acquired Parkinsonism:
This manifests as a result of some other disorder

Hereditary Parkinsonism:
Off late, many genes that are directly related to some cases of PD have been discovered. The terms ‘Familial Parkinson’s disease’ and ‘Sporadic Parkinson’s Disease’ are used to differentiate genetic types of PD from truly idiopathic forms of PD

Parkinson plus syndromes or multiple system degeneration:
Other than causing movement related disorders, PD also gives rise to several non-motor types of symptoms such as sensory deficits, cognitive difficulties or sleep problems. Parkinson plus diseases are Primary Parkinsonism’s with additional features. They include – multiple system atrophy, progressive, supranuclear palsy, cortico-basal degeneration and dementia with Lewy bodies.

Parkinsons disease symptoms

Signs and Symptoms

Motor signs and symptoms –
Tremor:
It is the most apparent and well known symptom. Around 30% of individuals with PD do not have tremor at disease onset.
Most of the patients develop tremors as the disease progresses
The tremor is usually a ‘rest tremor’. It is maximal when the limb is at rest. It disappears with voluntary movement and sleep.
It typically appears the most distal part of the limb. At the onset of disease, the tremor appears in only a single arm or leg. It later becomes bilateral.
Pill rolling tremor – Feature of tremor in PD is a pill-rolling tremor. It is the tendency of the index finger of the hand to get into contact with the thumb and perform together a circular movement. It represents an earlier pharmaceutical technique of manually making pills using the index finger and thumb.

Hypokinesia (slowness of movement):
The patient finds difficulty to plan, initiate and execute movements
Performance of sequential and simultaneous movement is hindered

Bradykinesia (slowness of movement) is a very disabling symptom in the early stages of disease. There are problems in performing daily tasks which require fine motor control such as writing, sewing or getting dressed. Similar tasks done by both hands or by both legs differ. Bradykinesia is modified by the activity or emotional state of the patient.

Rigidity:
Rigidity means stiffness and resistance to the limb movement. It is caused by increased muscle tone (excessive and continuous contraction of muscles).
The rigidity of Parkinsonism can be of 2 types – uniform (lead-pipe rigidity) or ratchet (cogwheel rigidity).
Rigidity may be associated with joint pain (initial manifestation)
In early stages, rigidity is often asymmetrical. The rigidity tends to affect the neck and shoulder muscles. Later the muscles of the face and extremities are affected. As the disease progresses, the rigidity affects the whole body and reduces the ability to move

Postural instability:
It is a symptom of later stages of the disease. It leads to impaired balance and frequent falls. Secondary bone fractures can also occur.
Instability is absent in the earlier stages especially in younger people
Up to 40% people experience falls and around 10% people may have falls weekly, with number of falls proportional to severity of the disease

Other motor signs and symptoms:
Gait and posture disturbances like – Festination (rapid shuffling steps and a forward-flexed posture when walking),
Speech and swallowing disturbances including voice disorders,
Mask like face expression,
Small handwriting

Neuropsychiatric signs and symptoms –
Neuropsychiatric disturbances of Parkinson’s disease include disorders of speech, cognition, mood, behaviour and thought. The symptoms can be mild to severe.

Most cognitive deficit is executive dysfunction includes – Problems with
Planning,
Cognitive flexibility,
Abstract thinking,
Rule acquisition,
Initiating appropriate actions and
Inhibiting inappropriate actions and
Selecting relevant sensory information

Other difficulties:
Fluctuations in attention
Slowed cognitive speed
Memory affected (recalling learned information is difficult)
Visuo-spatial difficulties (tests of facial recognition and perception of orientation of drawn lines is not performed properly)
Risk of developing dementia (6 times greater in comparison to general population), Dementia is associated with reduced life quality in people with PD and their caregivers, increased mortality and higher probability of needing nursing home care
Behaviour and mood alterations (common in Parkinson’s disease with cognitive impairment, usually present in PD with dementia) – Depression, apathy and anxiety are common
Impulse control behaviours – viz medication overuse and craving binge eating, hypersexuality or pathological gambling
Psychotic symptoms – include hallucinations or delusions (in 4% people with Parkinson’s disease)

Other symptoms (impairment of other body functions in Parkinson’s disease) –
Sleep problems – daytime drowsiness, disturbances of REM sleep or insomnia (in around 13% patients on dopaminergic medications)

Symptoms of altered autonomic nervous system functions –
Orthostatic hypotension (low BP upon standing)
Oily skin
Excessive sweating
Urinary incontinence
Altered sexual function
Constipation and gastric dysmotility
Vision and eye abnormalities – decreased blink rate, dry eyes, deficient ocular pursuit (eye tracking) and saccadic movements (fast automatic movements of both eyes in the same direction), difficulties in directing gaze upward and blurred or double vision
Impaired sense of smell
Sensation of pain and paraesthesia (skin tingling and numbness)

Diagnosis

Medical history and neurological examination forms the mainstays of diagnosis of Parkinson’s disease
We don’t have any lab test which will clearly identify the disease
Brain scans help in ruling out other disorders with similar symptoms
Relief of motor impairment to administration of levodopa confirms diagnosis of PD
Proof that the person had PD – presence of Lewy bodies in the midbrain on autopsy

Other causes that can produce secondary PD are:
Alzheimer’s disease
Multiple cerebral infarction
Drug induced Parkinsonism
Parkinsonism plus syndromes – such as Progressive supra-nuclear palsy & multiple system atrophy should be ruled out (anti-PD medicines are less effective in these syndromes)

Parkinsonism plus syndromes are marked with – faster progression rates, early cognitive dysfunction or postural instability, minimal tremor or symmetry at onset.

Genetic forms are usually classified as PD. The terms familial PD and familial Parkinsonism are used for disease entities having autosomal dominant or autosomal recessive patterns of inheritance

Diagnostic criteria (according to UK PD Society Brain Bank) – Diagnosis of PD requires presence of slowness of movement (bradykinesia) plus either rigidity, resting tremor or postural instability. Other possible causes for these symptoms need to be ruled out. 3 or more of the following features are required during onset and evolution of the disease:
Unilateral onset
Tremor at rest
Progression in time
Asymmetry of motor symptoms
Response to levodopa for at least 5 years
Clinical course of at least 10 years
Appearance of dyskinesias induced by the intake of excessive levodopa

Other investigations:
CT and conventional MRI brain scans of people with Parkinson’s disease usually appear normal. These are useful in ruling out other diseases that can be secondary causes of Parkinsonism such as basal ganglia tumours, vascular pathology, hydrocephalus etc
Diffusion MRI helps in discriminating between typical and atypical parkinsonism
Dopaminergic function in basal ganglia can be measured with different PET and SPECT radiotracers

Kampavata Ayurvedic perspective

Kampa or Vepathu is a word which closely resembles and explains the mechanism of tremors in Ayurveda. Kampa Vata is an Ayurvedic term given to a condition which closely resembles Parkinson’s disease. The term Kampa Vata is a word made up of two root words. Kampa – means tremors and Vata means Pathological increase or aggravation of Vayu wrt quality and quantity.

Thus Kampavata means a diseased condition in which the tremors are manifested due to a pathological increase of Vata.

Pathological increase of Vayu need not cause Kampa at all the times and in all people. When Vata increases pathologically, its qualities also tend to increase in a pathological way. That doesn’t mean to tell that, all the ‘qualities of Vata’ need not have to increase at the same time. In some pathological manifestations of Vayu, only one quality of Vata is increased, in some others 2 or more qualities may be increased and all qualities may show pathological variations in a few conditions.

Law of dominance – Even when many qualities are increased simultaneously, there may be partial aggravation of a single quality in comparison to other qualities. The dominant quality tends to produce the predominant symptom or symptoms of the disease or the disease itself and the dormant quality (the quality of Vata that is aggravated comparably lesser in comparison to the dominant character or quality) remains suppressed without manifesting.

In Kampa Vata – the Chala Guna or the quality of Vata which is responsible for movements gets increased in comparison to other qualities. Being a predominantly aggravated character, the Chala Guna owing to its property of inducing movements brings about exaggerated movements of the body parts, which is beyond the normal range of movements. These movements will not be under the control of our will. This is called Kampa or Vepathu. The same will be called Tremors in modern terms.

Note: The other qualities of Vata are – Laghu (lightness), Ruksha (dryness), Khara (rough), Sukshma (minuteness or subtleness) etc

Kampa Vata might get manifested in 2 ways:
As an independent disease (Primary Manisfestation)
As a symptom of another disease process (Secondary Manifestation)

As primary manifestation

Kampa Vata as a Primary Manisfestation –
Kampa is one of the symptoms of Vata Vriddhi (pathological aggravation of Vayu_. Therefore when Vata tends to pathologically increase in the body, especially its chala guna, it produces Kampa. Such a condition is called Kampa Vata. In the initial stage of pathogenesis, when the Vata with respect to its chala guna accumulates (Sanchaya), in its sites of existence and operation (in vata predominant sites like Large intestine, pelvis, thighs, ear, bones, skin etc), Kampa or tremors are manifested in a feeble form and occurs in longer psace of time i.e. the time period between 2 attacks of tremors is quiet large. The patient may not be able to notice these tremors because they are passing affairs and short lived. Their intensity is not so severe that they could be accounted for.

When the vitiation of Vata with respect to its chala guna further exceeds in its own sites (places manifested above) – the stage of Prakopa of Vata and later tends to spread towards other tissues and organs, which do not belong to it i.e. stage of Prasara – the Kampa or tremors may be moderately manifested and noticed. The frequency with which the tremors occur also will be more and they will occur within a gap of short durations, shorter than as occurs in Sanchaya and Prakopa stage of Vata vitiation. It is easier to treat Kampa or tremors if the disease is diagnosed in these 3 earlier stages of the disease.

When the Vata further gets aggressive and starts accumulating and lodging within the weak tissues, especially the muscles and soft tissues (stage of Sthanasamshraya), the background for Kampavata or Parkinson’s disease is well set. The tremors might occur more frequently and in an evident form. The premonitory symptoms (Purvarupa’s) of the disease will be manifested in this stage. This means to tell that the signs and symptoms of PD will be seen in a feeble and unclear form in this stage. The disease itself will be manifested with less strength.

If Parkinson’s is not treated in the 4th stage of pathogenesis i.e. Sthanasamshraya stage, the Vata starts invading the tissues, makes them weak and gets permanently lodged in them. Now the pathogenesis gets completed with sufficient tissue damage. This leads to clear cut manifestation of signs and symptoms (Rupa) of the disease. This stage of the disease will be called the Vyakta Avastha. Vyakta means to become visible or to be seen. This means to tell that the disease becomes clearly seen and diagnosed in this stage. It is in this stage of full blown disease with its hallmark signs and symptoms that the disease will be named as Kampavata or Parkinson’s disease.

The next stage is called as Bheda Avastha or the stage of complications. This stage occurs when the disease is not treated properly in Vyakta stage as a consequence of progression of disease pathology beyond control and severe irreversible damage of the tissues. The complications include wide array of psycho-somatic symptoms like joint pains, gait disorders, dementia, delirium, depression, sleep disorders etc.

As secondary manifestation

Kampa Vata as a secondary manifestation –
Kampa or Vepathu or Kampa Vata can be secondary to a primary disease.
Other names used synonymous to Kampa are – Vepathu, Sphurana and Spandana.

In this context we shall consider all these terms in relation to tremors and Parkinson’s disease. Below mentioned are the conditions in which tremors occur as secondary manifestation according to Ayurvedic references –

As a premonitory symptom (Purvarupa) in –
Apasmara (epeilepsy) – as Hrit Kampa (tremors in the region of heart)
Vatarakta (gout) – Janvasthu sandhishu sphuranam (tremors in knee joint and other joints)

As a symptom (Lakshana) in –
Anantavata – a type of headache
Apatantraka – Grand mal
Apatanaka – Repeated convulsions, Status epilepticus
Vataja Apasmara – Epilepsy caused due to Vata morbidity or vitiation of Vata
Vatadhika and Vata-Kaphaja Amlapitta – Gastritis or GERD caused due to vitiation of Vata or both Vata and Kapha
Ardita – Facial palsy or Facial Paralysis (mentioned as Vepathu)
Aakshepaka – Spasms, convulsions
Vataja Ashmari – Urinary stones caused due to vitiation of Vata (mentioned as Vepathu)
Uraha kshata – chest injuries (mentioned as Vepathu)
Kalaya Khanja – Limp (mentioned as Vepathu)
Kaanda bhagna – fracture of shaft of bones (as spandana)
Gridhrasi – Sciatica (as sphurana and spandana)
Jara shosha – wasting disorder caused due to ageing
Kaphaja, Vataja, Shokaja (grief induced) and Bhutabhishangaja (infections) type of Jwara (fevers)
Jwaramukti Purvarupa – in premonitory condition of recovery from fever
Tamaka shwasa – Bronchial asthma
Trushna nigrahaja daha – Burning sensation caused due to forcible withholding of thirst reflex (as vepathu)
Vataja Parinamashula – Peptic ulcer and colic caused by vitiated Vata
Vataja Pandu – Anaemia caused due to vitiation of Vata
Vataja madaatyaya – Alcoholic intoxication caused due to vitiation of Vata (as shira kampa or head tremors)
Vataja Masurika – Small pox caused by vitiated Vayu or Vata
Mutra-sharkara – urinary gravel / gravular stage of calculi (as vepathu)
Murcha – unconsciousness or syncope caused due to vitiation of Vata (Vataja murcha) and as an effect of poisons (Vishaja Murcha)
Bala graham – infectious and idiopathic diseases occurring at infancy including affliction of Naigamesha graham (as spandana), Sheetaputana graham (as vepathu) and Skanda graham
Vatadhika Vatarakta – Gout caused due to vitiation of Vata (as Vepathu, sphuranam)
Visha – affliction of poisons
Vataja Visarpa – Herpes caused due to vitiation of Vata (as sphurana)
Sannipataja Vishphota – Blisters caused due to aggravation of all the 3 dosha’s (as vepathu)
Vepathu / Sarvangakampa – tremors occurring in the whole body
Krimija Shira shula – headache occurring due to infections and worm infestations (as shira sphurana – head tremors)
Sarvanga kupita vata – Vata aggravated in the whole body (as Gatra sphurana – full body tremors)
Sutika roga – diseases occurring during involution / post-partum period
Yamala hikka – Yamala type of hiccough (as shiro greeva kampa – tremors of head and neck) and Mahati Hikka – Mahati type of Hiccough (as Sarva gatra kampa – full body tremors)
Kampa or Vepathu as Upadrava (complication) –
Madatyaya – alcoholic intoxication (as vepathu)
Vataja prameha – Diabetes or urinary diseases caued by vitiatied Vata
Vatarakta – Gout (as Vepana)
Visuchika – cholera
Vata Vyadhi – Vata disorders
Vrana – ulcers and wounds (as Vepathu)

As Asadhya lakshana

As sign of bad prognosis (Asadhya Lakshana) in –
Ardita – Facial palsy or Facial paralysis
Apasmara – Epilepsy (as pratisphurana)
Bhuta unmade – type of insanity (idiopathic origin)
Urustambha – thigh stiffness (as vepana)
Vata vyadhi – Vata disorders

Causes

Causes of Kampa Vata –
Since Kampa Vata is a disorder in which tremor is the predominant symptom caused by vitiation of Vata dosha, all causes which vitiate Vata can be considered as the causative factors of Kampa Vata.

Since Kampavata is caused by vitiated Vata, all the foods, life activities which cause aggravation of Vata are the causes of Kampa Vata or Vepathu. Below mentioned are the causes of Vata Prakopa (vata vitiation) and hence causes of Kampa Vata vis-à-vis Parkinson’s disease or Parkinsonism.

Vata Prakopaka Karanani (Causative factors responsible for Vata vitiation):
Vyayama – Excessive exercises
Apatarpana – Fasting in excess
Prapatana – Fall, injury
Bhanga – Fractures
Kshaya – Depletion of tissues
Jaagarat – Excessive vigil (awakening all night)
Veganam cha vidharanat – Suppression of natural body urges (reflexes)
Ati shuchi – Excessive administration of cleansing procedures (Panchakarma)
Shaityadi – Excessive consumption of cold foods and activities
Traasaat – Fear
Ruksha – Excessive consumption of dry foods
Kshobha – Irritation
Kashaya – Excessive consumption of astringent foods
Tikta – Excessive consumption of bitter foods
Katu – Excessive consumption of pungent foods
Vari-ghanagame – cloudy and rainy season
Parinate anne – After the digestion of food
Aparahne – Evening

Vega dharana and Udeerana – Vata also gets increased due to avoiding the natural urges (vega) created in the body such as reflexes for hunger, thirst, sleep, voiding urine and stools, sneeze etc. Similarly, Vata gets vitiated when these reflexes are forcibly created when they are not naturally impending. This leads to a condition called Udavarta in which the Vata moves in a haphazard way in the body disturbing all the other governing factors and produces various psychosomatic illnesses. Thus one should not make a habit of forcibly withholding the natural body urges and reflexes and also not to force them out of the body. This when holistically practised, will keep Vata in control and prevent many diseases from manifesting. This is true with any Vata disorder including Kampa Vata (Parkinson’s disease).

Patho-physiology

How does Kampa Vata occur?
Vayu tends to pathologically increase in terms of quality and quantity when you consume vata vitiating foods and gets exposed to activities (physical and mental) which tend to aggravate Vata as mentioned above. This Vayu when gets vitiated beyond limitations (prakopa) tends to move all over the body in a haphazard and violent way (prasara). The vitiated vata can get lodged in any weak dhatu (tissue), impart pathological changes therein, damage the tissue and initiate a disease process (sthana samshraya).

In case of Kampa Vata, the vitiated vayu gets lodged in weak mamsa dhatu (muscle tissue) (and medo dhatu – fat tissue). Mamsa dhatu or muscle tissue is the abode of Kapha dosha. That means to tell that, Mamsa dhatu and Kapha always are related to each other in an abode-resident (ashraya-ashrayi) relationship. Thus pathological increase or decrease of Vata has a serious impact and damaging effect on muscle tissue. Dhatu kshaya (depletion of tissues) is also a direct cause for aggravation of Vata. This condition is generally called as Mamsagata Vata which tends to produce painful conditions of the muscle like myalgia, fibromyalgia etc. But if the Chala guna of Vata gets vitiated severely in comparison to the other qualities of Vata, after vitiated Vata getting lodged in the muscle tissue, it causes tremors and hence will be named as Kampa Vata since Kampa or tremors caused by exacerbation of chala guna of Vata is the presenting symptom of the disease. This can be compared to Parkinson’s disease explained in the modern medical science.

When the vitiated vata damages the muscle tissue considerably, the signs and symptoms (vyakta) of Kampa Vata, predominantly the tremors get manifested. If the condition is not taken care of even in this condition, many complications (bheda) are manifested.

Kampa – a symptom of Vata Vriddhi (pathological increase of Vata: When Vata gets vitiated, it produces some symptoms. These symptoms include – Karshya (emaciation / wasting), Karshnya (discolouration), Ushna Kamitva (affinity towards hot foods and comforts), Kampa (tremors) Anaha (flatulence), Shakrud graham (constipation), Bala bhramsha (loss of strength), Nidra bhramsha (sleeplessness), Indriya Bhramsha (loss of strength and functioning of sense organs, low perception by sense organs), Pralapa (Delirium), Bhrama (giddiness), Deenata (helplessness, Depression) etc.

In the above said explanation it is clear that Kampa is an invariable component of a syndrome called Vata Vriddhi. But the Kampa will not be consistent in this condition because it is only pathological increase of Vata. Once Vata is taken care of by Vata palliating treatments and medicines, Kampa will come down.

But in Kampa Vata, the vitiated Vata invades and damages the tissues and causes disease. In this condition, meagre pacification of Vata will not be fruitful in treating PD. We have to break the Samprapthi (pathogenesis) and separate the invader (Vata) from the invaded (tissues like muscles, fat, marrow and bone). The vitiated Vata should be expelled from the body through effective treatments like Snehana, Virechana and Vasti and also some disease modifying herbal compounds. At the same time the tissues should be strengthened and fortified by administration of Balya, Brimhana, Jeevaniya and Rasayana herbs and compounds. Proper management of diet, sleep, and lifestyle is needed for maintenance of the obtained relief and to prevent relapse. Kampa is also a symptom of Vata Vitiation (Prakopa, 2nd stage of pathogenesis according to Ayurveda)

Kampa Vata Lakshana (Symptoms of Kampa Vata – Parkinson’s disease) –
The predominant symptom of Kampa Vata is Kampa or Kampana (Vepathu) – Tremors. Since Kampa Vata is a Vata disorder (Vata Vyadhi), the signs and symptoms of Vata vitiation will also be the symptoms of KampaVata. All symptoms of Vata vitiation might not accompany Kampa but different symptoms might be associated in different people. It depends on the gradient of vitiation of Vata, qualitatively as well as quantitatively. The symptoms of Kampa Vata are as mentioned below –
Kampa – tremors
Karshnya – discolouration
Karshya – Emaciation, wasting
Ushna Kamitva – Liking towards hot food and comforts
Anaha – flatulence
Shakrut graham – constipation
Bala bhramsha (loss of strength)
Nidra bhramsha (sleeplessness)
Indriya Bhramsha (loss of strength and functioning of sense organs, low perception by sense organs)
Pralapa (Delirium)
Bhrama (giddiness)
Deenata (helplessness, Depression)
Sramsa – laxity of joints
Bhramsha – subluxation or dislocation of joints
Vyasa – involuntary movements of limbs
Sanga – stagnation of urine, stools and sweat etc unwanted materials in the body, loss of voice
Bheda – splitting pain in the body parts
Sada – weakness of body parts
Harsha – horripulation
Varta – dryness of stools, pellet form
Spanda – mild spasms, tremors or tics
Toda – pricking pain
Veshtana – cramps
Kharatva – roughness of the body
Shyavarunata – blackish-blue discolouration of nails, skin etc
Kashaya asyata – feeling of astringent taste in the mouth
Shosha – dryness of the body parts (dehydration)
Shula – colic
Supti – numbness
Sankocha – constriction of body parts
Stambha – stiffness of body parts
Panguta – lameness etc

While discussing the treatment of Kampa Vata (Ayurvedic perspective), whenever I mention Kampavata, it should be understood as Kampavata with the above said associated symptoms.

Sarvanga Vata –
This is one pathological manifestation of vitiated Vata in which the whole body is afflicted by the mischievous activities of morbid Vata. (Sarvanga=full body).

Sarvanga kupite vaate gaatra sphurana bhanjane
Vedanaabhihi pareetascha sphutanti iva asya sandhayaha (Ref – Charaka Chikitsa 28/25)
The symptoms of Sarvanga Vata (Vata vitiated in the whole body) are – Gatra sphurana (tremors all over the body), bhanjanam (crushing pain), severe splitting or blasting type of pain all over the body, especially in the joints.
This condition too looks similar to the manifestation of Parkinson’s disease. PD can also be treated on the lines of Sarvanga Vata.

Ayurvedic treatment principles

Parkinson’s disease (Kampa Vata) should be treated on the lines of treatment of:

Vata Vyadhi –
Vata disorders in general, because it is Vata which is controlling the whole body and the morbidity of Vata can afflict the functions of each and every cell, tissue and organ in the body. In PD, the primary manifestation is Tremors which are caused by vitiated Vata.
When Vata is vitiated to peaks it tends to deplete all the tissues in the body, pitta and kapha doshas, the immunity and life span of an individual.
Thus control of Vata is the key in treatment of Parkinson’s disease. Vata shaman (pacifying the Vata) and Vatanulomana (propelling the morbid vata in a downward direction) by the administration of effective medications and treatment will lead to the effective cure of PD.
Avoiding Vata prakopaka ahara vihara
Avoiding food and life style activities which aggravate Vata include –

Vata Prakopaka Karanani (Causative factors responsible for Vata vitiation):
Vyayama – Excessive exercises
Apatarpana – Fasting in excess
Prapatana – Fall, injury
Bhanga – Fractures
Kshaya – Depletion of tissues
Jaagarat – Excessive vigil (awakening all night)
Veganam cha vidharanat – Suppression of natural body urges (reflexes)
Ati shuchi – Excessive administration of cleansing procedures (Panchakarma)
Shaityadi – Excessive consumption of cold foods and activities
Traasaat – Fear
Ruksha – Excessive consumption of dry foods
Kshobha – Irritation
Kashaya – Excessive consumption of astringent foods
Tikta – Excessive consumption of bitter foods
Katu – Excessive consumption of pungent foods
Vari-ghanagame – cloudy and rainy season
Parinate anne – After the digestion of food
Aparahne – Evening

Broader horizon of tackling Parkinson’s disease (Kampa Vata) –
Kampa Vata vis-à-vis Parkinson’s disease can be treated on the lines of treatment protocol of the below said conditions –
Vata Vyadhi
Sarvanga Vata
Mamsagata Vata (vitiated Vata afflicting muscle tissue)
Medo gata Vata (vitiated Vata afflicting fat tissue)
Asthigata Vata (vitiated Vata afflicting bone tissue)
Majjagata Vata (vitiated Vata afflicitng bone marrow)
Unmada Chikitsa (treatment line up of insanity and mental disorders)
Apasmara Chikitsa (treatment of epilepsy and forgetfulness)
Pakshaghata Chikitsa (treatment line up of paralysis or hemiplegia)
Ardita Chikitsa (treatment protocol of facial palsy or facial paralysis)

All the above said conditions might be different conditions from Parkinson’s disease but the principles of the treatment explained in the above said contexts are also useful in PD. With the fear of elaborate coverage, I have skipped explaining each and every condition (mentioned above) and their treatment. But I have taken the gist of the medications and treatments done in all these disorders and summed up in the below said discussion of treatment of Kampa Vata (Parkinson’s disease).

Ayurvedic therapies for PD:

Bahya Chikitsa (External treatment)

Abhyanga (Therapeutic / Preventive Herbal Oil Massage) –
Abhyanga means performing a massage. Massage is done using herbal (medicated) oils. Medicated oil and mixture of medicated ghee is also preferred in some cases. Disturbed movements are generally caused due to aggravated Vayu / Vata. Taila (oil) is said to be the best remedy for vitiated Vayu. Massage not only alleviates the morbid Vayu but also provides significant relief from complaints like tremors and other symptoms associated with tremors in Kampa Vata or Parkinson’s disease. It nourishes and strengthens the muscles, bones, joints and soft tissues and also rejuvenates them. Abhyanga when performed as a daily practice keeps up the health of the muscles, joints and soft tissues, provides strength and immunity, postpones ageing of tissues and helps in their rhythmic and coordinated movements. Ayurveda advocates whole body massage with herbal oils to be practiced on a daily basis.

Best oils used for Abhyanga:
Balashwagandhadi Tailam
Ashwagandha ghritam
Tila Taila (Sesame oil)
Ksheerabala Tailam
Mahamasha Tailam
Dhanwantaram Tailam
Mahanarayana Tailam
Sahacharadi Tailam
Yashtimadhu Tailam
Prasarinyadi Tailam
Guggulutiktakam Ghritam etc.

Swedana (Fomentation / Sudation / Sweating therapy) –
Sweda means sweating. Swedana means a treatment procedure in which sweating is induced. Swedana is usually done after Abhyanga and or Snehana (administration of medicated oils and ghee for oral consumption in metered doses, as a pre-treatment procedure for cleansing treatments like Vamana – Therapeutic vomiting and Virechana – Therapeutic purgation).
After Swedana, the cells get activated and flush the toxins away. The cellular metabolism improves and we feel light and at ease. Swedana done after abhyanga or snehana enables free circulation, provides strength and rejuvenates the whole body.
There are many types of Swedana as explained in Ayurvedic texts. But the below mentioned types of Swedana are generally practiced in the treatment of PD –

Bashpa Sweda –
Bashpa means steam, Sweda means sweating therapy. This type of fomentation includes giving steam to the whole body after having administered a whole body massage.
The below mentioned are the variants of Bashpa Sweda which can be effectively used for the relief of Kampa Vata or Parkinson’s disease –

Sarvanga Bashpa Sweda This is a steaming treatment conducted so as to cover the whole body. This is done by making the patient (who has been given a massage) sit inside a steam-chamber keeping his head out of the box, through an opening given for that purpose. After proper steaming, the patient is let out of the steam chamber or cabin. Swedana should be carefully carried out and care should be seen that excessive steaming should not be given. Care also should be taken so as to avoid excessive swdeating.

Nadi Sweda – This procedure is carried out by boiling vata alleviating drugs like Rasna, Eranda, Dashamula, Devadaru etc in a container with lid; say for example a pressure cooker. The nozzle of the cooker is connected with a heat resistant tube. When the contents in the vessel or cooker are boiled to optimum, the steam is released through the opening of the tube until the whole body sweats. This method is a substitute to Sarvanga sweda. In this, the whole body will not be subjected to steaming at a time.

Pinda Sweda (Bolus Fomentation) –
Pinda means bolus, Sweda means inducing sweating. Thus in Pinda sweda, the medicaments, generally hot or boiled to tolerable temperature are tied in a cloth so as to make a bolus. The bolus is gently rubbed over the entire body. Heat is provided until sweating occurs but with caution. There are many variants of Pinda sweda, the name is given on the basis of the material / medicaments tied within the bolus. The best Pinda sweda’s in business are mentioned below –

Churna Pinda Sweda (Podikkizhi) – Churna means herbal powder, Pinda means bolus, Sweda means fomentation. As the name indicates herbal powders are filled and tied in a sterile cloth so as to form a bolus. The powder is used either in dry form (high kapha-ama-meda conditions where rukshana or drying therapy is needed, presence of swelling and stiffness etc symptoms) or in wet form (snigdha sweda) i.e. after frying the herbal powder in medicated oils (high vata-pitta conditions, presence of inflammatory and or degenerative changes,). In Parkinson’s disease, Snigdha or wet form of Churna Pinda Sweda is used. The bolus is dipped in pan consisting of oils before rubbing over the body. After heating, the boluses are gently rubbed over the entire body (in circular motion over joints and vertically over the muscles). Read more about Podikkizhi

Note –
Ama means metabolic wastes created by low metabolism and indigestion which have a sticky nature and has a tendency to produce pain and stiffness.
Meda means fat.

Herbal powders used for Churna Pinda Sweda are:
Rasnadi Churna,
Dashamula sukshma churna
Kolakulatthadi Churna etc
Churna pinda sweda is done for 45-60 minutes

Patra Pinda Sweda (Leaf bolus fomentation) – Patra means leaves of medicinal plants, Pinda means bolus, Sweda means fomentation. As the name indicates sliced (chopped) leaves of medicinal plants having vata-alleviating, anti-inflammatory, anti-degenerative and analgesic properties are filled and tied in a sterile cloth so as to form a bolus.

The fresh leaves of the Vata alleviating herbs are collected and sliced. Ex. Leaves of Eranda (Ricinus communis – castor plant), Nigundi (Vitex nigundo), Arka (Calotropis gigantean), etc are sliced. The sliced leaves are fried in herbal oil (oils used for Abhyanga). Grated coconut, sliced lemon, Rasnadi Churna, Haridra (Turmeric powder), Methika (fenugreek), Saindhava Lavana (rock salt), Eranda Taila (castor oil) are also added and fried. The sliced leaves are tied in a bolus to form a Patra Pinda (Leaf bolus). A couple of boluses are prepared

The leaf bolus is dipped in warm oil; temperature of the bolus is tested and used for giving fomentation. The boluses are rubbed over the body in a gentle way (as good as massaging with bolus). The procedure is repeated many times for a period of 45-60 minutes.

Shashtika Shali Pinda Sweda / Navarakizhi – Fomentation with Shashtika Rice (rice grown in 60 days duration) processed with medicinal decoctions packed in boluses shall be preferred when there are signs of severe Vata vitiation and degeneration of joints and tissues. The boluses are dipped in milk processed with vata alleviating decoctions (with decoction of Bala mula and Dashamula) and rubbed over the body continuously for 60-90 minutes. It rejuvenates, nourishes and strengthens the body and also pacifies the vitiated Vata.

Avagaha (Tub bath or Sitz bath) –
A big tub so as to accommodate the body of a person (like bathing tub) is filled with warm oils, ghee and oils and medicated (processed with medicinal drugs) milk. The patient of Kampa Vata is given a massage and made to sit in the tub for 45-60 minutes. The temperature of the liquid medicines is kept constant by re-heating the medicine.

Sarvanga Dhara and Kaya Seka (Pizhichil) –
Dhara or Seka means to pour in streams. In this, medicaments including herbal oils and processed milk is poured in streams all over the body along with gentle stroking for a fixed duration. This is highly effective in combating morbid Vata, Pitta and Rakta and recovery from PD. Kaya Seka or Pizhichil is stream pouring of medicated oils over the body for a fixed amount of time (60-90 minutes). Kaya Seka, Sarvanga Takra dhara (medicated buttermilk) or Sarvanga Ksheera dhara (medicated milk) are generally preferred in Parkinson’s disease.

Read more about Sarvanga Dhara and Pizhichil here

Murdhni Tailam –
Murdhni means head, Tailam means oil. Thus Murdhni Tailam is a procedure of application, stream pouring or pooling of medicated oils over the head. Taila or oil is the best remedy in combating vitiated Vata. Head or brain is said to be Uttamanga (best or predominant organ or part of the body) in Ayurveda. It has controlling centres of the entire body apart from being a seat of sense organs, emotions, intellect and memory. It is also a Marma sthana (vital organ) which comprises of more than 30 vital spots, the injury of which can cause many deformities or death.

Application, pouring or pooling of oil over the head means to fortify the head, sense organs and brain. Murdhni Taila not only nourishes and strengthens the head and organs located therein; it also acts as a best stress controller. It is good for hairs and scalp bones and soothes the nerves. It promotes good sleep and keeps us healthy. The Prana Vayu, Sadhaka Pitta, Alochaka Pitta and Tarpaka Kapha which are the basic factors in the head which control the overall functioning of the body and mind will be kept in a condition of balance by Murdhni Taila. Murdhni Tailam is the best treatment option for those suffering from Kampa Vata vis-à-vis Parkinson’s disease.

Murdhni Tailam is of 4 types –
Shiro-Pichu – A small sterile cotton pad is dipped in medicated oil and kept on the crown of the scalp. A bandage cloth is tied around the head and kept in place for a few hours.
Shiro Abhyanga – Massage of head using medicated oils
Shiro Dhara – Stream pouring of medicated liquids including oils, buttermilk, milk etc over the head for a certain fixed duration
Shiro Vasti – Pooling of medicated oil over the head, enclosed within a vertical chamber or compartment constructed over the head in the form of a cap.
All the above said methods of Murdhni Taila are useful in controlling Vata and curing Kampa Vata, but Shiro Vasti is the ultimate choice.
The same oils used for dhara and abhyanga can be used for Murdhni Tailam procedures.
Shiro Lepa – Application of herbal pastes made up of the herbs which control Vayu over the head is called Shiro Lepa. The paste is left in place until it starts getting dry and later removed. Alternatively, leaves of Castor plant, Vitex negundo etc plants which are known for Vata alleviating properties is placed over the applied paste such that there is a small opening at the crown of the head. The entire application with leaves is loosely tied with a thin bandage cloth to hold them in position. At regular intervals, medicated oil is slowly put into the opening in drops so as to keep the paste moist.

Abhyantara Chikitsa (Internal treatment)

This includes some of the Panchakarma (5 treatment procedures which are used in body cleansing / detoxification) treatment procedures which should be skilfully chosen as per the condition of the dosha and the diseased.

Snehapana –
Sneha means medicated oil or ghee, Pana means intake. Snehapana is a procedure in which the patient is made to drink metered doses of oils and ghee which are processed with medicines. This is given in 3 forms:

Shodhana Sneha – Here the medicated ghee or oils are given in higher doses so as to cause saturation in the body. The dosage is increased every day until all the cells of the body get saturated or the symptoms of proper administration (Samyak Snigdha Lakshanas) are obtained or until the patient develops aversion towards the medicine. It is usually given early in the morning on empty stomach. It is given for patients for whom Shodana (body cleansing treatments like vamana – therapeutic emesis or virechana – therapeutic purgation) has been planned. After the body cells have been saturated with the Sneha, Swedana (whole body steaming) is given followed by administration of Vamana (therapeutic emesis) and or Virechana (Therapeutic purgation) is given.

Virechana or therapeutic purgation is one of the best treatments for Vayu disorders including Kampa Vata or Parkinson’s disorder

Shamana Sneha – The same medicaments are given in smaller doses when the extent and strength of the disease and diseased are low or moderate. It is given when the patient feels hungry, before food. The intention is to pacify the vitiated Doshas and not to expel them.

Brimhana Sneha – The sneha is given for strengthening purposes and also for promoting bulk. The medicated oil or ghee is given mixed with food.

Nitya Snehapana – In this, small metered doses of Snehana is given on a daily basis either first thing in the morning or at bedtime usually mixed in hot milk or gruels. This method is followed when the patient is not able to take higher doses or is not fit for Panchakarma procedures. It acts as a lubricant and rejuvenates the joints and soft tissues. It also helps in tackling the morbid Vata and Pitta which are causing backache.

Important medicines used for Snehapana –
Ashwagandhadi Ghritam
Saraswatha Ghritam
Panchagavya Ghritam
Brahmi Ghritam
Kalyanaka Ghritam
Guggulutiktakam Ghritam
Tiktakam Ghritam
Indukantham Ghritam
Bala Tailam
Rasnadi Ghritam
Mahamasha Tailam
Ksheerabala Tailam
Brihat Chagaladya Ghritam
Amritaprasha Ghritam
Gandharvahastadi Eranda Tailam (for purgation)
Nimbamritadi Eranda Tailam (for purgation) etc

Virechana –
Virechana means therapeutic purgation. Virechana is given after the administration of Snehapana and Swedana. Virechana expels the morbid dosha’s especially pitta and vata, thus preventing or curing the Parkinson’s disease. Virechana, especially the purgation or laxatives having an oily (medicated oil or castor oil base) base are highly effective in combating morbid Vata and are useful in treatment of Kampa Vata. Ex. Gandharvahastadi tailam, Nimbamrutadi Eranda Tailam etc

Nitya virechana – This is a variant of Virechana where in the medicines which have a laxative property are given in low doses on a daily basis. This will target expulsion of morbid doshas on a daily basis, as and when they are formed and tending to cause some pathological changes in the low back area. Apart from expelling morbid vata and pitta, it also relieves pain, inflammation and stiffness of the degenerating joints.
Best medicines used for Virechana (depending on the morbid dosha and morbidity):
Gandharvahastadi Kashayam
Gandharvahastadi Eranda Tailam
Nimbamritadi Eranda Tailam
Higutriguna Tailam
Shaddharana churnam
Trivrit Leha
Sukumara Leha
Kalyana Gulam
Sukumara Ghritam
Sukumaram Kashayam
Hingutriguna leham
Triphala Churnam
Narayana churnam etc

Vasti –
Vasti means medicated enemas. Vasti or Basti is said to be the best treatment for vitiated Vayu, which is the chief culprit in Kampa Vata vis-à-vis Parkinson’s disease. When Vayu is controlled by the action of Vasti all the other disturbed body elements fall into rhythm and equilibrium. Vasti strengthens the joints and soft tissues, rejuvenates health, aids fast healing and prevents recurrence.

Virechana and Vasti act as effective purgatives. Purgation is essential for detoxification and controlling vitiated Vata.

Vasti is given in the below mentioned forms:
Asthapana Vasti (Kashaya Vasti) – Herbal decoctions or milk (ksheera vasti) processed with decoctions is given as enemas.
Below mentioned are some of the best Asthapana Vasti’s in Parkinson’s disease –
Erandamuladi Kashaya Vasti
Dashamula Kashaya Vasti
Dashamula Ksheera Vasti
Raja Yapana Vasti
Mustadi Yapana Vasti etc.

Sneha / Anuvasana Vasti – Medicated oils or ghee is used for enemas. It is given in combination with Asthapana Vasti (alternatively).

Matra Vasti – It is also a variant of Anuvasana Vasti but given in small doses. It can be given on a daily basis. Anuvasana and Matra vasti pacifies vitiated Vayu and strengthens the nerves and nervous system.
Best medicines used for Anuvasana and Matra Vasti are –
Ashwagandhadi Ghritam
Brihat Chagalyadi Ghritam
Guggulutiktakam Ghritam
Tiktakam Ghritam
Ksheerabala Tailam
Mahamasha Tailam
Sahacharadi Tailam
Brihat Saindhavadya Tailam
Bala Tailam etc.

Nasya – Nasal instillation of medicated ghee and / or oils is called Nasya. Brihmana Nasya (oil / ghee prepared using strengthening medicines) is preferred in Parkinson’s disease (Kampa Vata).
The below said medicaments are used for Nasya:
Ksheerabala Tailam,
Ksheerabala tailam 101,
Dhanwantaram Tailam 101,
Mahamasha Tailam
Shadbindu tailam

Treating Vayu:
Sneha – Administration of medicated oils / ghee, Massage, oil pouring etc
Sweda – Steaming / sudation / sweating therapy
Mridu shodanam – Evacuation treatment (mild cleansing treatments like Virechana etc)
Svadu bhojana – Consuming sweet foods
Amla bhojana – consuming sour foods
Lavana bhojana – consuming salt foods
Ushna bhojana – Hot and fresh foods
Abhyangam – Massage with herbal oils
Mardana – Tapping the body with closed fists after application of vata alleviating oils
Seka – Pouring of medicated oils over the body in streams
Paishtika Madhya – Alcohol or fermented products prepared with flours
Goudika Madhya – Alcohol or fermented products prepared with jaggery
Snigdhoshna Vasti – Medicated enemas with oils and ghee, given luke warm
Deepana pachana sneha – Oils and ghee processed with deepana (appetizer) and pachana (digestant) drugs

Ayurvedic herbs

Useful Ayurvedic herbs in Parkinson’s disease (Drugs alleviating Vata) –

Devadaru – Cedrus deodara
Kushta – Saussurea lappa
Bala – Sida cordifolia
Atibala – Abutilon indicum
Shallaki – Boswellia settata
Agnimantha – Clerodendrum phlomidis
Guduchi – Tinospora cordifolia
Eranda – Ricinus communis
Shatavari – Asparagus racemosus
Punarnava – Boerhavia diffusa
Dashamula – Roots of 10 drugs

Gatavatavastha (Mamsagata Vata and Medogata Vata) –
Kampa Vata or Parkinson’s disease is a pathology related to disturbances in Mamsa dhatu (flesh or muscle tissue) and Medo dhatu (fat tissue) and also the channels (srotas) related to their metabolism and distribution. Thus Kampa Vata can be handled on similar lines of treating Mamsagata Vata or Medogata Vata.

Gatavata is a condition wherein the vitiated Vata gets lodged in some tissue and disturbs the qualitative and quantitative integrity of that particular dhatu (tissue) or organ leading to either depletion or destruction (partial or whole) of the target tissue / organ.

Here the vitiated Vata getting lodged in Mamsa (muscle / flesh) and Meda (fat) tissues and exacerbation of its chala guna causes Parkinsonism / Kampa Vata. Therefore PD shall be treated on the lines of Mamsagata Vata and Medogata Vata

In these conditions treatments and medicines so as to pacify vata (Vatashamana) or remove vata (Vatanulomana) should be considered. Apart from this Balya (strengthening) and Brimhana (bulk promoting) medicines along with Rasayana’s (tissue rejuvenators, anti-ageing agents) should be given to increase the cellular immunity and aid their recovery (in terms of quality and quantity)

The below said are said to be the best in tackling Mamsagata Vata and Medogata Vata –
Virechana – Therapeutic purgation
Niruha vasti – Medicated decoction enemas
Shamana chikitsa – Palliative treatments and medicines

Other strategies to be adopted in the treatment:
Brimhana –
Brimhana means bulk promoters. Medicines which improve the muscle bulk also strengthen the muscles. They also provide nutrition and nourishment to the tissues. These medicines can be used both during treatment and also during follow up. They also improve the neuro-muscular conductivity and enhance muscle power and metabolism. These medicines are highly effective in PD.
Below said are the best Brimhana drugs –
Ksheerini – Ipomoea digitata
Rajakshavaka – Euphorbia hirta
Ashwagandha – Withania somnifera
Kakoli – Roscoea procera
Ksheerakakoli – Lilium polphyllum
Vaatyaayini – Sida cordifolia
Bhadraudani – Sida rhombifolia
Bhaaradvaaji – Thespesia lampas
Payasya – Pueraria tuberose
Rushyagandha – Argyreia speciosa

Others:
Navanna – New paddy / rice
Shali – Rice
Masha – Black grams
Godhuma – Wheat
Ikshu vikara – Sugarcane and its derivatives (jaggery, sugar etc)
Anupa mamsa – Flesh of animals living in marshy areas
Audaka mamsa – Flesh of animals living in water
Dadhi – curds
Dugdha – milk
Ghrita – Ghee
Vrishya dravya – Aphrodisiacs
Rasayana dravya – Rejuvenators

Ashwagandha is the best drug in dealing with neuro-muscular disorders.

In Kaphavarana conditions, it should be implemented only during the follow up i.e. after destroying the Kapha envelope over the Vata.

Balya –
Balya means strengthening. The drugs which increase the vitality and strength of the body are called Balya Dravyas. Increase in vitality and strength also depicts an increase in immunity. Bala is said to be the function of Oja (essence of body tissues in the body). Balya drugs also maintain this oja in the body while enhancing the immunity. Tissue strength and immunity are less in Parkinson’s disease.

Below mentioned are the best Balya drugs –
Aindri – Bacopa monnieri
Rushabhi – Mucuna pruriens / Fagonia cretica / Mucuna monosperma
Atirasa (Shatavari) – Asparagus racemosa
Rushyaprokta – Argyreia petaloides
Payasya – Roscoea procera
Ashwagandha – Withania somnifera
Sthiraa – Uraria picta
Rohini – Picrorrhiza kurroa
Bala – Sida cordifolia
Atibala – Abutilon indicum

Santarpana –
Santarpana means nourishing or refreshing. The below said are best in Santarpana –
Mamsarasa – Meat soup
Paya – milk
Ghrita – Ghee
Snana – Refreshing bath / shower
Vasti – Enema
Abhyanga – Massage
Tarpana – Refreshing drinks

Jeevaneeya herbs –
Jeevaneeya means to promote longevity. Jeevaneeya drugs also provide an anti-inflammatory and anti-oxidant effect on the body. Thus they are highly beneficial in Parkinson’s disease (Kampavata / Vepathu)
Below mentioned are the best Jeevaneeya drugs –
Jeevaka – Crepidium acuminatum / Malaxis acuminate
Rishabhaka – Manilkara hexandra / Malaxis muscifera
Meda – Polygonatum verticillatum
Mahameda – Polygonatum cirhifolium
Kakoli – Roscoea purpurea
Ksheerakakoli – Lilium polyphyllum
Mudgaparni – Phaseolus trilobus / Vigna trilobata
Mashaparni – Teramnus labialis
Jivanti – Leptadenia reticulate
Madhuka – Glycyrrhiza glabra

Vayasthapana –
Vayasthapana dravyas means longevity promoters or anti-ageing drugs.
Below mentioned are the best Vayasthapana drugs –
Mandukaparni – Centella asiatica
Sthira – Desmodium gangeticum
Punarnava – Boerhavia diffusa
Guduchi – Tinospora cordifolia
Haritaki – Terminalia chebula
Amalaki – Emblica officinalis
Rasna – Alpinia galangal
Shweta (Shweta aparajita) – Clitoria ternatea
Jivanti – Leptadenia reticulate
Atirasa – Asparagus racemosa

Rasayana –
Rasayana includes all those drugs, medicines, treatments and activities which enhance the quality of all the tissues in the body and improve the strength and immunity. They are the best immune-modulators and anti-ageing medicines. Some of them are best antioxidants.
The below said are the best Rasayana’s in Kampa Vata (Parkinsonism) –
Brahmi – Bacopa monnieri
Mandukaparni – Centella asiatica
Shankapushpi – Convolvulus pluricaulis
Vidari – Pueraria tuberosa
Jivanti – Leptadenia reticulata
Punarnava – Boerhavia diffusa
A Guduchi – Tinospora cordifolia
malaki – Emblica officinalis
Haritaki – Terminalia chebula
Vidanga – Embelia ribes
Pippali – Piper longum
Shatavari – Asparagus racemosa
Shilajit
Bibhitaki – Terminalia bellirica
Yashtimadhu – Glycyrrhiza glabra
Sthiraa – Desmodium gangeticum

Vajikarana –
Vajikarana means aphrodisiacs. Some of the Vajikara dravyas are also highly effective in Parkinson’s disease. They are –
Kapikachchu – Mucuna pruriens
Ashwagandha – Withania somnifera
Shatavari – Asparagus racemosus
Masha – black gram
Ksheera – milk
Ghrita – Ghee etc

Kapikachchu has an unparalleled impact on healing Parkinson’s disease (Kampa Vata). Its medical efficacy has been proved by research works.

Other herbs useful in PD –
Shunti – Zingiber officinale
Gokshura – Tribulus terrestris
Manjishta – Rubia cordifolia
Nirgundi – Vitex negundo
Musta – Cyperus rotundus
Haridra – Turmeric / Curcuma longa

Ayurvedic medicines

Best Ayurvedic medicines for Parkinson’s Disease:

Kashayam (Herbal decoctions):
Maharasnadi Kashayam
Gandharvahastadi Kashayam
Pathyakshadhatryadi Kashayam
Prasarinyadi Kashayam
Punarnavadi Kashayam
Ashtavargam Kashayam
Drakshadi Kashayam
Sahacharadi Kashayam
Dashamula Kashayam etc

Asava / Arishtam (Herbal fermented liquids):
Dashamularishtam
Balarishtam
Saraswatharishtam
Ashwagandharishtam
Punarnavasavam
Draksharishtam

Vati / Gulika (Tablets):
Yogaraja Guggulu
Mahayogaraja Guggulu
Trayodashanga Guggulu
Panchatikta ghrita guggulu
Brahmi Bati
Smritisagar Rasa
Vatakulantaka Ras
Vatagajankush Ras
Sameera pannaga ras
Brihatvatachintamani Ras
Mahavata-vidhwans Ras
Chandraprabha vati
Shallaki
Sutashekara ras
Trailokya chintamani Ras
Chaturbhuja Ras
Tapyadi loha

Best Rasayana’s / Lehyas (Rejuvenators and confections) in PD:
Vanari kalpa
Vajikara Rasayanam
Ashwagandha Rasayanam
Ajashwagandha Rasayanam
Ajamamsa Rasayanam
Drakshadi Rasayanam / Drakshadi Leham
Kushmanda Rasayanam
Chyavanaprasham
Dashamula Haritaki

Others (Churna, Satwa, Bhasma etc):
Kapikachchu churna
Ashwagandha churna
Shatavari churna
Giloya Satva
Rajata bhasma
Yashada Bhasma
Swarna Bhasma
Swarna Makshika Bhasma
Mukta pishti

Modern management

Management of Parkinson’s disease – Modern perspective –

There is no cure for PD
Medications, surgery and multidisciplinary management can provide relief from symptoms.
Main families of drugs useful in treating motor symptoms are – Levodopa, Dopamine agonists and MAO-B inhibitors (stage of the disease should be decided for the choice of drug family)
Surgery and deep brain stimulation (when medicines are not able to control symptoms)
Palliative care (in the final stages of disease) – improves the quality of life

Rehabilitation:
Exercise programmes are recommended for people with PD
Speech and mobility problems are believed to improve with rehabilitation
Regular exercise with (or without) physiotherapy can be useful to maintain and improve mobility, strength, flexibility, gait and quality of life.
Monitored exercise programmes are seen to improve motor symptoms, mental and emotional functions, daily living activities and quality of life
Relaxation techniques are seen to improve flexibility and range of movements for those experiencing rigidity
Slow rotational movements of the extremities and trunk, rhythmic initiation, diaphragmatic breathing and meditation techniques promote relaxation
Rehabilitation of gait includes improving gait speed, base of support, stride length, trunk and arm swing movement etc. important strategies are – utilizing assistive equipment (pole walking and treadmill walking), verbal cueing (manual, visual and auditory), exercises (marching and PNF patterns) and altering environments (surfaces, inputs, open v/s closed).
Strengthening exercises improves strength and motor functions
Deep diaphragmatic breathing exercises are beneficial in improving chest wall mobility and vital capacity in advanced PD’s. Exercises may improve constipation.
Lee Silverman voice treatment (LSVT) is most widely practiced treatments for speech disorders associated with PD.
Occupational therapy aims to promote health and quality of life by helping people with the disease to participate in as many daily living activities as possible.

Palliative care –
This is a specialized medical care to improve quality of life for both the patient and the family by providing relief from the symptoms, pain and stress of illness.
As Parkinson’s disease is not a curable disease, all treatments are focussed on slowing decline and improving the quality of life and therefore they are palliative in nature.
Palliative care specialists can help Parkinson’s disease patients to improvise physical symptoms, emotional factors such as loss of function and jobs, depression, fear and existential concerns
Palliative care team can help members to take proper decisions on complex and emotional topics such as when to go for feeding tube, non-invasive ventilator, tracheostomy, cardiopulmonary resuscitation etc which the patients may hesitate to wish for or are confused regarding when to opt out for them

Other treatments:
Planning of balanced diet based on periodical nutritional assessments is essential because PD presents with gastrointestinal dysfunction leading to constipation and gastroparesis (food remaining in the stomach for a longer period than normal). Diet planning is also needed to maintain nutritional levels by avoiding weight loss or gain.
Progressive stages of PD presents with swallowing difficulties (dysphagia). In these cases thickening agents for liquids and an upright posture when eating reduces the risk of choking. Gastrostomy to deliver food directly into the stomach is possible in severe cases.
Repetitive transcranial magnetic stimulation is said to temporarily improve levodopa-induced dyskinesias (not proved)
There is no strong evidence to prove the efficacy of vitamins, food additives, practice of acupuncture, Qigong or Tai chi though works have been done to figure out their usage
Fava beans and velvet beans ate natural sources of levodopa and are eaten by people having PD

Risk Factors –
Sustained head injuries
Taking milk in midlife (in large quantities)
Amphetamines drug, antipsychotic drugs, neuroleptic drugs and calcium channel blockers taken in excess risk PD.
Methamphetamine
Exposure to pesticides
Exposure to manganese

Prognosis

PD invariably progresses with time
UPDRS (Unified Parkinson’s Disease Rating Scale) and MDS-UPDRS, Hoehn and Yahr scale are the popular scales used as severity rating methods in clinical study
Untreated motor symptoms advance aggressively in early stages of PD and more slowly later
Untreated individuals are expected to lose independent ambulation after an average of 8 years and be bedridden after 10 years
Medication has improved prognosis of motor symptoms. At the same time it is a new source of disability because of the undesired effects of levodopa after many years usage. In people taking levodopa, the progression time of symptoms to a stage of high dependency (from caregivers) may be over 15 years.
Rate of motor decline is greater in those with less impairment at the time of diagnosis. Cognitive impairment is more frequent in those who over 70 years of age at symptom onset.
Disability is initially related to motor symptoms. As the disease advances, disability is more related to motor symptoms that do not respond adequately to medication such as swallowing / speech difficulties and gait / balance problems and also to motor complications which appear in up to 50% of individuals after 5 years of levodopa usage. After 10 years most people with the disease have autonomic disturbances, sleep problems, mood alterations and cognitive decline. These further increase disability.

The life expectancy of people with Parkinson’s disease is reduced. Mortality ratios are around twice in comparison to unaffected people. Below mentioned are risk factors for mortality in PD –
Cognitive decline and dementia
Old age at onset
More advanced disease state
Swallowing difficulties

A disease pattern mainly characterized by tremor as opposed to rigidity predicts an improved survival. Death from aspiration pneumonia is twice as common as in healthy population
In 2013 PD resulted in about 103,000 deaths globally up from 44,000 deaths in 1990. The death rate increased from an average of 1.5 to 1.8 per 100,000 during that period.

Research works

Animal models – Search for new animal models of the disease is on. A model organism is a non-human species that is extensively studied to understand biological phenomena, with the expectation that discoveries made in the organism model will provide insight into the workings of other organisms. Animal models showing some features of PD are used in research.

Gene therapy – Gene therapy typically involves the use of a non-infectious virus (i.e. a viral vector such as the adeno-associated virus) to shuttle genetic material into a part of the brain. The gene used leads to the production of an enzyme that helps to manage PD symptoms or protects the brain from further damage.

Neuro-protective treatments – investigations on neuroprotection are at the forefront of PD research. Several molecules have been proposed as potential treatments. Agents currently under investigation include anti-apoptotics, antiglutamatergics, monoamine oxidase inhibitors, promitochondrials, calcium channel blockers and growth factors. Pre-clinical research targets alpha-synuclein. A vaccine that primes the immune system to destroy alpha-synuclein – PD01A has entered clinical trials.

Neural transplantation – since 1980’s fetal, porcine, carotid or retinal tissues have been used in cell transplants, in which dissociated cells are injected into the substantia nigra in the hope that they will incorporate themselves into the brain in a way that replaces the dopamine-producing cells that have been lost. Stem cell transplants are a recent research target, because stem cells are easy to manipulate. Stem cells transplanted into the brains of rodents and monkeys have been found to survive and reduce behavioural abnormalities.

A genetic mutation increases the risk of PD linked to pesticides. The gene mutation causes nerve cells that produce dopamine to lose their protection from pesticide damage. The body uses dopamine to send messages to the part of the brain that controls movement and coordination. (Sanford Burnham Medical Research Institute, news release, Nov.27, 2013)

People living near a steel factory or another source of high manganese emissions are at higher risk. Even those living in rural areas and drink well water are also at risk.

Exposure to more pesticides by gardeners put them in risk of developing degenerative brain disease. This suggests that they have to wear protective equipment while spraying pesticides. (Researches at the University of Aberdeen in Scotland, studies)

Consumption of large quantities of milk and calcium in midlife is a risk factor for PD (Neurology 2005)

Head injuries, sustained head injuries following accidents and boxing is a risk factor (studies)

Amphetamines drug, antipsychotic drugs, neuroleptic drugs and calcium channel blockers taken in excess risk PD. (Neurosciences, study at Riyadh, 2013, Drug induced PD, a clinical review)

Points of interest –
When proteins are taken with levodopa, they reduce the effectiveness of the drug. Therefore when levodopa is introduced, excessive protein consumption is discouraged and a well balanced Mediterranean diet is recommended. In advanced stages low protein-products like bread or pasta is recommended for similar reasons.

To minimize protein interactions, levodopa should be taken 30 minutes before meals.

Epidemiology

PD is the 2nd most common neurodegenerative disorder after Alzheimer’s disease and affects approximately 7 million people globally and 1 million people in USA
Population wise – its proportion is about 0.3% in industrialized countries.
Age wise – PD is common in older people, most cases occur after 50 years of age. It is more common in elderly and rates rises from 1% in those over 60 years of age to 4% of the population over 80. Mean age of onset is around 60 years. 5-10% cases are classified as young onset PD and they begin between ages of 20-50 years.
Parkinson’s disease caused in young people is called young onset PD
It may be less prevalent in those of African and Asian ancestry (finding is disputed)
According to some studies PD is more common in men than in women
Number of cases per year of PD is between 8 and 18 per 100,000 persons per year
Some studies say that PD risk is more in those exposed to pesticides and a reduced risk in smokers

History

Early sources of symptoms resembling PD can be found in Egyptian papyrus, Ayurvedic medical treatise, Bible, Glen’s writings etc
After Galen, there are no references related to PD until 17th century
In 17th and 18th centuries authors like Sylvius, Gaubius, Hunter and Chomel wrote about the disease, though not in detail
In 1817 James Parkinson (English doctor) published his essay reporting 6 cases of paralysis agitans. An ‘Essay on the Shaking Palsy’ described the characteristic resting tremor, abnormal posture, gait, paralysis and diminished muscle strength and also the progression of the disease. The disease is thus named after James Parkinson. He had published the first detailed description in ‘An Essay on the Shaking Palsy’ in 1817
Trousseau, Gowers, Kinnier Wilson and Erb, Jean-Martin Charcot are the early Neurologists who added to the knowledge of the disease.
Contribution of Jean-Martin Charcot towards PD is excemplary. His studies between 1868 and 1881 were a landmark in understanding the disease. He made the distinction between rigidity, weakness and bradykinesia. He also championed the renaming of the disease in honour of James Parkinson.
In 1912 Frederic Lewy described microscopic particles in affected brains. They were later named as Lewy bodies.
In 1919 Konstantin Tretiakoff reported that the substantia nigra was the main cerebral structure affected. This finding was confirmed by further studies published by Rolf Hassler in 1938.
Arvid Carlsson identified the underlying biochemical changes in the brain in 1950’s through his works on neurotransmitter dopamine.
Olen Hornykiewicz showed the role of dopamine on PD
In 1997, alpha synuclein was found to be the main component of ‘Lewy bodies’ by Spillantini, Trojanowski, Goedert and others
Anticholinergics and surgery were the only treatments until the arrival of levodopa.
Levodopa was first synthesized in 1911 by Casimir Funk. It entered clinical practice in 1967 and brought about a revolution in the management of PD
By the late 1980’s deep brain stimulation introduced by Alim-Louis Benabid and colleagues at Grenoble, France, emerged as a possible treatment
Parkinson’s disease Day is followed on 11th April which happens to be the birthday of James Parkinson. On this day public awareness campaigns and camps to tackle this disease are arranged. A red tulip is used as the symbol of the disease.

Society and culture –
The costs of PD to society are high. Inpatient care, nursing home costs, reduced productivity, burden on caregivers etc contribute to economic costs. PD reduces quality of life of those with the disease and their caregivers.
11th April, birthday of James Parkinson has been designated as Parkinson’s disease day. A red tulip was chosen as the symbol of the disease in 2005.
Advocacy organizations which are selflessly working on PD – National Parkinson Foundation, Parkinson’s Disease Foundation, American Parkinson Disease Foundation, American Parkinson Disease Association, European Parkinson’s Disease Association etc

Notable cases –
Actor Michael J. Fox has PD. The Michael J. Fox foundation aims to develop a cure for PD. He received an honorary doctorate in medicine from Karolinska Institute for his contributions to research in PD
Professional cyclist and Olympic medallist Davis Phinney was diagnosed with PD. He started Davis Phinney Foundation in 2004 to support Parkinson’s research.
Muhammad Ali, boxer – was diagnosed with PD. He is called ‘world’s most famous Parkinson’s patient’

Just Before finish –
Ayurveda has excellent remedies to offer in many neurological and psychosomatic disorders. In this article I have tried to cover almost all the options available for you to combat and conquer Parkinson’s disease. All treatments and medicines are time tested and have been in practise since ages. Results are astonishing and exemplary. It is not all about popping up some pills or drinking herbal decoction and anticipates great changes. It needs a holistic approach to get rid of this disease and a serious determination on the part of the patient too.

A proper diagnosis in an Ayurvedic way, by a qualified and experienced doctor, a cleanly drawn protocol of treatment with effective combinations of herbal medicines, treatments, disease modifying medicines, antioxidants, immune-modulators, lifestyle changes and diet changes will be like hitting a hammer on hot iron. The game of permutations and combinations is left out for the doctor to decide. All you need to do is look for an Ayurvedic doctor in your neighbourhood!
Click to Consult Dr Raghuram Y.S. MD (Ayu)

12 thoughts on “Parkinson’s disease: Prevention, Ayurvedic Treatment, Remedies”

  1. Thanks for your detailed article. As my father in law suffers from this disease, your article helps me understand him better and care for him more efficiently.

    Reply
  2. I decided to share this to help someone out there who is still held with Parkinson’s.
    My dad suffered from parkinson’s for 18 years and we traveled round the world from one hospital to another neurologist and spent thousands of dollars and even got scammed in this process of seeking a cure and the problem still persisted. He acted weird and aggressive and this was so scary. All thanks to Dr Lusanda who was able to use his herbal medicine to cure him permanently. He is one of the Honest men out there. If you want to contact him on how to get this herbal medicine or for info just reach him directly on drlusandaherbal(AT)gmail(dot)com or website on www(dot)drlusandaherbals(dot)weebly(dot)com Thanks admin.

    Reply
  3. Hi, thanks for your valuable information abpt p.d, but why u didn’t mention the most important ayurvedic drug atmagupthachurna in your article? Plz discuss about atmagupthachurna

    Reply
    • Kapikacchu – Mucuna pruriens, that is written in the above article is atmagupta Churna.

      Reply
  4. Thank you for the awareness. I am the one who trusts ayurvedic treatment more than traditional medications for treating Parkinson’s disease symptoms. Having green tea daily in the morning has a very good effect Parkinson’s symptoms. As a Parkinson’s sufferer do not break your exercise and yoga routine. Just be connected with physical activities whether it is yoga, aerobic, cycling, skipping, boxing and walking.

    Reply
  5. Very informative paper!

    Correction required, please:
    “Ushna Kamitva” is once translated as “affinity of cold ….” and some lines below “affinity to hot ….”.

    Reply
  6. One of the most valuable articles on the subject. Thank you.

    Can you please let me know whether Sinemet interacts with the Ayurvedic drugs listed under best Ayurvedic medicine for Parkinsons and if taken how many hours before or after Sinemet they should be taken?

    Reply

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