New finding: A small, National Institutes of Health (NlH)-funded trial of coenzyme Q10 (a natural nutrient, also known as CoQ10, that is present in all human cells) found that taking 1,200 mg daily may slow disease progression in patients with early-stage Parkinson's.
More study is needed to confirm that CoQ10 does indeed slow the progression of the disease. Because the dosage of CoQ10 that was studied is only mildly effective, additional research also is needed to determine whether a higher dose Q,400 mg of CoQ10 daily) works better.
Implication: Parkinson's patients who are eager to try all possible therapies should ask their doctors about taking 1,200 mg daily of CoQ10. No side effects have been shown at this dosage.
DOPAMINE AGONISTS
Levodopa, also known as L-dopa is the gold standard in treating Parkinson's. But many patients taking levodopa eventually develop uncontrolled flailing movements—a condition called dyskinesia—and motor fluctuations, in which medication levels in the brain drop and Parkinson's symptoms return.
Some doctors prefer to hold off prescribing levodopa in favor of a drug known as a dopamine agonist, which mimics the effects of dopamine in the brain and causes neurons to react as though sufficient amounts of dopamine were present. Dopamine agonists reduce Parkinson's- related disabilities—and work even better when combined with levodopa.
Dopamine agonists approved by the FDA are bromocriptine (Parlodel), pergolide, pramipexole (Mirapex), ropinirole (Requip) and apomorphine (Apokyn). Rotigotine, the only dopamine agonist offered in patch form, is available in Europe for patients who have trouble swallowing or want the convenience of using a patch once a day. The FDA approved the drug in2007, but it was recalled in 2008.
Recent finding: In a two-year study of 186 early-stage Parkinson's patients, brain scans of those taking ropinirole or levodopa suggest that dopamine agonists may slow the decline of Parkinson's disease. Levodopa was found to worsen the disease, although patients' symptoms improved.
Implication: Because medications may interfere with brain scan results, more study is needed to confirm these findings. Ropinirole should be considered as treatment. Among the most likely candidates are younger patients who experience motor fluctuations and dyskinesia from levodopa.
Important: Ropinirole has been shown to cause side effects, such as sleepiness, nausea, hallucinations and, in rare cases, odd behavior such as compulsive shopping and gambling.
MINOCYCLINE AND CREATINE
In an NlH-sponsored clinical trial,200 Parkinson's patients who did not yet require medication were randomly assigned to receive 200 mg daily of the antibiotic minocycline, 10 g daily of creatine (a nutritional supplement used to increase lean body mass and strength) or a placebo for 12 months.
Minocycline was studied due to its anti-inflammatory effects. Inflammation has been detected in the brains of Parkinson's patients. Creatine is an energy booster, and decreased energy utilization is a problem in Parkinson's disease. Minocycline and creatine were found to be potentially beneficial.
Implication: More study is needed before minocycline or creatine can be prescribed as a treatment for Parkinson's disease.
DEEP BRAIN STIMULATION
New finding: An advanced surgical technique known as deep brain stimulation (DBS) has been shown to provide significant benefit to moderate and advanced Parkinson's patients for up to four years after the onset of treatment.
With DBS, a surgeon implants an electrode inside the brain to stimulate specific brain sites that control movement. The electrode is connected to a palm-sized pacemaker that is implanted beneath the skin just below the clavicle. By stimulating key parts of the brain, the pacemaker helps alleviate motor symptoms, such as tremor.
Serious complications from DBS, such as stroke, occur in fewer than 2% of patients. More common side effects include speech impairment, personality and/or mood change, depression and a decline in cognitive function in older patients.
Implication: DBS is especially helpful for people who respond to levodopa but suffer from dyskinesia and wearing off of the drug. DBS is covered by Medicare and many other forms of health insurance.
Typical cost: $30,000 to $60,000.
