Huntington's disease (HD) is a neurological (nervous system)
condition resulting from genetically programmed degeneration of neurons (brain
cells) in certain areas of the brain. HD, previously known as Huntington's
chorea and chorea maior, affects up to eight individuals per 100,000. It
affects one out of 20,000 people of Western European descent and one out of one
million people of Asian and African descent.
HD causes uncontrolled movements, loss of intellectual
faculties, and emotional disturbance. HD is a familial disease, passed from
parent to child through a mutation in the normal gene. HD causes cells in
certain areas of the brain to slowly destruct. It usually starts in middle
adulthood. HD gradually gets worse over time. In one to three percent of individuals
with HD, no family history of HD can be found.
Affected people may be unable to take care of themselves and
may need to be put in an institution. Death occurs in most affected people
between 10 and 30 years after the disease is diagnosed. HD is not contagious.
Death is due to infection (usually pneumonia), fall-related injuries, or
suicide. The suicide rate for HD sufferers is much greater than the national
Some early symptoms of HD are mood swings, depression,
irritability, trouble driving, and trouble learning new things, remembering a
fact, or making a decision. When the condition progresses, difficulty in
concentrating on intellectual tasks may occur, and the patient may have
difficulty eating and swallowing. The rate of disease progression (worsening of
the disease) and the age of onset vary from person to person.
There is no cure and there are no treatments that slow the
progression of HD. Medication may be used to treat psychosis, depression, or
Brain cells in HD patients slowly die, so scientists are
paying close attention to the process of genetically programmed cell death that
occurs deep within the brains of individuals with HD.
Juvenile HD has an age of onset anywhere between infancy and
20 years of age. The symptoms of juvenile HD are different from those of
adult-onset HD in that they generally progress faster and are more likely to
exhibit rigidity and bradykinesia (very slow movement) instead of chorea
RISK FACTORS AND
Huntington's disease (HD) is an inherited condition caused
by a single abnormal gene. It is found in every country in the world. Each
child of an HD parent has a 50% chance of inheriting the HD gene. Because signs
and symptoms typically appear in middle age, some parents may not know they
carry the gene until they've already had children and possibly passed on the
trait. If a child does not inherit the HD gene, he or she will not develop the
disease and cannot pass it to subsequent generations.
A person who inherits the HD gene will eventually develop
the disease. Whether one child inherits the gene has no bearing on whether
other siblings will or will not inherit the gene. A genetic test, coupled with
a complete medical history and neurological and laboratory tests, helps
physicians diagnose HD. Testing before symptoms occur is available for
individuals who are at risk for carrying the HD gene.
Although the precise cause of cell death in HD is not yet
known, scientists are paying close attention to the process of genetically
programmed cell death that occurs deep within the brains of individuals with
HD. This process involves a complex series of interlinked events leading to
cellular suicide. Causes of cellular death in HD patients may include
excitotoxicity (overstimulation of cells by natural chemicals found in the
brain), defective energy metabolism (a defect in the cell's mitochondria where
energy is produced), oxidative stress (normal metabolic activity in the brain
that produces toxic compounds called free radicals that cause oxidation and
death of cells), and trophic factors (natural chemical substances found in the
human body that may protect against cell death).
Clinical studies for HD are focusing on understanding losses
of nerve cells and receptors in HD. Neurons (nerve cells) in the striatum (a
section deep within the brain) are classified both by their size (large,
medium, or small) and appearance (spiny or a-spiny). Each type of neuron
contains various combinations of neurotransmitters (brain chemicals).
Researchers have found that the destructive process of HD affects different
subsets of neurons to varying degrees. The hallmark of HD is selective
degeneration of medium-sized spiny neurons in the striatum. Studies also
suggest that losses of certain types of neurons and receptors are responsible
for different symptoms and stages of HD.
In spiny neurons, two types of changes have been observed,
each affecting the nerve cells' dendrites. Dendrites, found on every nerve
cell, extend out from the cell body and are responsible for receiving messages
from other nerve cells. In the intermediate stages of HD, dendrites grow out of
control. New, incomplete branches form and other branches become contorted. In
advanced severe stages of HD, degenerative changes cause sections of dendrites
to swell, break off, or disappear altogether. Investigators believe that these
alterations may be an attempt by the cell to rebuild nerve cell contacts lost
early in the disease. As the new dendrites establish connections, however, they
may in fact contribute to nerve cell death.
SIGNS AND SYMPTOMS
Although there is no sudden loss of abilities or exhibition
of symptoms, there is a progressive decline. Symptoms are classified as
physical, cognitive (the process of knowing and thinking), and psychological
(mental illnesses). Physical signs are usually the first noticed, but it is
unknown how long before the cognitive signs and psychopathology are affected.
Physical symptoms are almost always visible and cognitive symptoms are
exhibited differently from person to person.
Psychopathological symptoms vary more than cognitive and
physical symptoms, and may include anxiety, depression, a reduced display of
emotions called blunting, egocentrism, aggressive behavior, hypersexuality
(increased desire for sex), and compulsivity, which can cause addictions such
as alcoholism, drug addiction, and gambling.
Many patients are unable to recognize expressions in others
and also do not show reactions of disgust to foul odors or tastes. The
inability to recognize disgust in others appears in carriers of the Huntington
gene before symptoms are manifest.
The rate of disease progression and the age at onset vary
from person to person. Symptoms of Huntington's disease (HD) usually become
noticeable in the mid 30s to mid 40s. Adult-onset HD is characterized by
disabling, uncontrolled movements (chorea).
Some individuals with adult-onset HD may not have chorea.
They may appear rigid and move very little, or not at all, a condition called
The earlier the onset, the faster the disease seems to
progress. In general, the duration of the illness ranges from 10-30 years. The
most common causes of death are infection (most often pneumonia), injuries
related to a fall, and suicide.
Early signs and symptoms: Early signs of the disease vary
greatly with each individual. Normally, the earlier the symptoms appear, the
faster the disease progresses. Family members may first notice that the
individual experiences mood swings or becomes irritable, apathetic (a lack of
interest or concern), depressed, or angry. These symptoms may lessen as the disease
progresses or, in some individuals, may continue and include hostile outbursts
or deep bouts of depression. HD may affect the individual's judgment, memory,
and other cognitive functions.
Some early signs include having trouble driving, learning
new things, remembering a fact, answering a question, or making a decision.
Some may even display changes in handwriting. As the disease progresses,
concentration on intellectual tasks becomes increasingly difficult. In some
individuals, the disease may begin with uncontrolled movements in the fingers,
feet, face, or trunk. These movements, which are signs of chorea (involuntary
movements), often intensify when the individual is anxious. HD can also begin
with mild clumsiness or problems with balance.
Late signs and symptoms: Some individuals develop
involuntary movements later, after the disease has progressed. They may stumble
or appear uncoordinated. Chorea often creates serious problems with walking,
increasing the likelihood of falls. The disease can reach the point where
speech is slurred and vital functions, such as swallowing, eating, speaking,
and especially walking, continue to decline. Some individuals cannot recognize
other family members. Many, however, remain aware of their environment and are
able to express emotions.
Juvenile HD has an age of onset anywhere between infancy and
20 years of age. The symptoms of juvenile HD are different from those of
adult-onset HD in that they generally progress faster and are more likely to
exhibit rigidity and bradykinesia (very slow movement) instead of chorea. A
common sign of HD in a younger individual is a rapid decline in school
performance. Symptoms can also include subtle changes in handwriting and slight
problems with movement such as slowness, rigidity, tremor, and rapid muscular
twitching called myoclonus. Several of these symptoms are similar to those seen
in Parkinson's disease, and they differ from the chorea seen in individuals who
develop the disease as adults. These young individuals are said to have
akinetic-rigid HD or the Westphal variant of HD. People with juvenile HD may
also have seizures and mental disabilities.
The requirements for the diagnosis of Huntington's disease
(HD) include medical history, family history, neurological examination, brain
imaging testing (including magnetic resonance imaging or MRI and computerized
tomography or CT), laboratory tests, and genetic testing (when necessary).
Genetic testing - direct mutation analysis: HD is usually
inherited as an autosomal dominant trait, meaning that each child of an
affected parent has a 50% risk of inheriting the mutated gene for the disease.
Those who do not inherit a copy of the disease gene (or have a spontaneous
mutation in that gene) do not develop HD and cannot pass the disease trait on
to future generations.
Scientists discovered the gene for HD in 1993, called the
IT15 gene. This discovery helped in the development of specialized testing that
may help to confirm the diagnosis of HD in patients with an affected parent
with the disease. During such testing, blood samples are taken from patients
and DNA is directly analyzed for HD mutations.
Implications of genetic testing: Although the discovery of
the HD gene has facilitated predictive testing, the disease remains without a
cure, and treatment to slow or alter the disease's progression is currently
unavailable. Therefore, the availability of such testing continues to be
associated with numerous emotional, practical, and ethical concerns. Even
confirmed positive results do not provide accurate information concerning the
approximate age at onset, clinical severity, or rate of disease progression.
Individuals at risk for HD who are interested in the possibility of genetic
testing are referred to specialized, designated testing centers that have staff
with the necessary expertise and appropriate psychosocial counseling
Genetic counseling is the process by which patients or
relatives, at risk of an inherited disorder such as HD, are advised of the
consequences and nature of the disorder, the probability of developing or
transmitting it, and the options open to them in management and family planning
in order to prevent or stop passing the gene on. A genetic counselor is a
healthcare provider who helps in this process. At risk individuals include
those with a parent or sibling who has HD or individuals known to carry an HD
gene mutation. Individuals considering genetic testing require sufficient
information and appropriate counseling concerning the limitations of genetic
testing, their potential level of risk, and the possible implications of
results including negative, positive, or inconclusive findings.
Genetic counseling concerning the implications of positive
or questionable results should address a number of essential areas, including
long-term emotional and lifestyle issues, confidentiality concerns (including
the fact that patient confidentiality laws are governed by individual states),
and possible effects in the areas of health insurance, life insurance, and
employment. Counseling regarding the practical, emotional, and personal impact
on spouses as well as relatives who themselves may be at risk including
children, parents, or other relatives is important as well as family planning.
Individuals who are considering such testing may wish to have a relative or
close friend accompany them to their counseling sessions. A decision to receive
genetic testing must be carefully considered and made solely by the individual.
Predictive testing in children: It is generally believed
that pre-symptomatic testing should not be conducted in at-risk children who
are under the age of 18 years. Once individuals are aged 18 or older, they have
the choice to receive testing based on a personal, informed decision. An
exception may be made for children with symptoms characteristic of HD. In such
cases, genetic testing is provided in association with a thorough clinical
Prenatal testing: Predictive genetic testing before birth
(prenatal testing) is associated with unique concerns. For example, direct
mutational analysis that provides a positive result indicates that a parent
also carries the mutation. However, in some cases, parents may wish to
determine the risk of disease development in the developing fetus, yet may not
wish to know their own risk. Proper counseling in these individuals is
Physical and neurological assessment: Although predictive
genetic tests may indicate whether individuals carry the disease gene, these
tests are not able to confirm the onset of the disorder. Therefore, the
diagnosis of HD is also based on a thorough clinical evaluation including a
complete physical and neurological assessment and detection of characteristic
symptoms and findings (such as involuntary movements, emotional and behavioral
disturbances, and progressive dementia). A careful patient and family history
will also be taken. Neurological assessment may include testing to evaluate
cognitive (brain thinking and memory) status, reflexes, balance, and movement,
including evaluation of certain voluntary eye movements necessary in focusing
on moving targets.
Imaging techniques: Specialized brain imaging studies may
also provide evidence that supports a diagnosis of HD. For example, in
moderately advanced cases, computerized tomography (CT) scanning demonstrates
characteristic changes in the brain. CT scanning may also detect characteristic
enlargement of cavities of the brain (ventricles). In addition, positron
emission tomography (PET) scanning may show decreased glucose and oxygen
metabolism within the brain. Although such findings may also be associated with
other neurodegenerative disorders, they may be helpful in supporting a
suspected diagnosis of HD when associated with characteristic clinical findings
and family history. In general, neuroimaging is performed only if a symptomatic
individual does not have the HD gene and there is a suspicion of another
If a symptomatic individual is gene negative, diagnostic
studies may be conducted to eliminate other neurodegenerative disorders that have
similar symptoms including Wilson's disease (excessive copper in the body),
drug-induced tardive dyskinesia (involuntary movements of the tongue, lips,
face, trunk, and extremities), Sydenham's chorea (infectious disease caused by
bacteria that involves involuntary movements), systemic lupus erythematosus
(SLE, an autoimmune disease), or senile chorea (a symptom complex primarily
characterized by the development of chorea after age 60). Such studies may
include blood tests, neurophysiologic tests, and neuroimaging techniques.
Huntington's disease (HD) is not fatal in itself. People
with HD have a shorter life expectancy and die of life-threatening
complications related to the disease. Pneumonia (a bacterial infection in the
lungs and respiratory system) and heart disease (including heart attack,
congestive heart failure or CHF, and atherosclerosis or hardening of the
arteries) are the two leading causes of death for people with HD. Additionally,
HD patients have higher incidence of choking and respiratory complications,
gastrointestinal diseases (such as cancer of the pancreas), and suicide than
the non-HD population.
One of the chief symptoms of HD is the inability to produce
coordinated movements. In the latter stages of the disease, lack of muscle
coordination becomes more pronounced to the point that people have difficulty
swallowing. Swallowing is actually a complex series of movements by muscles in
the throat to ensure passage of food into the esophagus (gastrointestinal
tract) rather than the trachea (respiratory tract). As a result of these
movements, the epiglottis, a flap that acts as a valve in the throat, prevents
food from entering the airway. People with HD often lack this coordination, and
food will accidentally enter the respiratory tract, leading to choking.
Moreover, when food particles manage to get into the trachea (the "wind
pipe" leading to the lungs), instead of the esophagus (the "food
pipe" leading to the stomach), the lungs can become infected and cause
what is known as aspiration pneumonia.
Although pneumonia is relatively common among people in the
general population, it is only fatal in about five percent of HD cases.
Researchers have demonstrated that stress imposed on a person for prolonged
periods of time can severely damage the body's ability to fight off diseases.
Long-term release of the stress hormone cortisol, released from the adrenal
glands, can eventually suppress the immune system and cause other problems
including hypertension (high blood pressure), impaired glucose tolerance (lack
of blood sugar control), and weight gain. The physical, cognitive (thinking and
memory), and psychiatric symptoms of HD add a great deal of stress to everyday
life for these patients.
In addition, although studies have shown that suicide is not
a leading cause of death for HD patients, suicide rates are higher than among
the rest of the population. This is probably due to a combination of factors,
including neuropsychiatric changes induced by HD and the added stress of daily
life. Neuropsychiatric changes include mood disturbances (such as depression
and anxiety), bipolar disorder (manic depressive illness), psychosis, and
There is no treatment to fully stop the progression of the
disease, but symptoms can be reduced or alleviated through the use of
medication and care methods.
Medications: The use of medications may help to manage or
alleviate certain neurobehavioral or movement changes associated with
Huntington's disease (HD). Certain antipsychotic agents, such as haloperidol
(Haldol©), or benzodiazepines, such as clonazepam (Klonopin©), may partially
suppress involuntary movements and help to control psychiatric (mental)
abnormalities, including severe agitation, hallucinations, or psychotic
delusions. Because antipsychotic therapy may have potentially severe adverse
effects, including the development of tardive dyskinesia (neurological
condition that involves involuntary movements of the tongue, lips, face, trunk,
and extremities), such medications should only be used to treat chorea if the
condition is functionally disabling. In addition, these agents should be
prescribed at the lowest possible dosages and periodically discontinued if
possible (drug holidays). Benzodiazepines may also be associated with certain
side effects, including fatigue (extreme tiredness) and drug dependency.
Monoamine-depleting agents (monoamines are brain chemicals),
such as reserpine (Serpasil©), may alleviate chorea (involuntary movements)
with a decreased risk of causing tardive dyskinesia. However, these agents may
aggravate or cause drowsiness, depression, and fine motor tremors or have other
serious, life-threatening adverse effects, including neuroleptic malignant
syndrome (a neurological disorder that includes high fever, sweating, unstable
blood pressure, stupor, muscular rigidity, and autonomic dysfunction which
includes blood pressure and breathing) and agranulocytosis (failure of the bone
marrow to make white blood cells for the immune system).
Medical management may also include administration of
certain drugs to help alleviate depression, anxiety, or obsessive-compulsive
behaviors potentially associated with HD. These drugs may include
antidepressants such as paroxetine (Paxil©), fluoxetine (Prozac©, Sarafem©),
and sertraline (Zoloft©).
Lithium (Lithobid© or Eskalith©) or valproic acid (Depakote©,
Depakene©) may be prescribed to combat excitation and severe mood swings,
similar to bipolar disorder. Medications may also be needed to treat the severe
obsessive-compulsive rituals of some individuals with HD.
It is important to note that the side effects associated
with certain medications may be difficult to differentiate from signs of HD.
Most drugs used to treat the symptoms of HD have side effects such as fatigue,
restlessness, or hyperexcitability. Any medication regimen needs to be assessed
on a regular basis to determine the benefits and possible adverse effects of
specific therapies and evaluate the need for continued treatment.
Late in the course of the disease, some patients with HD
develop signs of parkinsonism, such as fine motor tremors. These symptoms
typically are not responsive to antiparkinsonism medications, such as levodopa
(L-dopa), a precursor of dopamine (a brain chemical), or agents that mimic the
effects of dopamine (amantadine or Symmetrel©). In most patients, these agents
may worsen involuntary movements. However, there have been a few reports in
which patients with parkinsonism associated with late-onset HD have responded
to levodopa. In addition, the treatment of juvenile HD may include prescribing
such antiparkinsonian agents.
Investigational treatments: Experimental studies for the
treatment of HD include transplantation of human (stem cells) or pig fetal
cells. Stem cell research is investigational and the side effects are not
known. Also, researchers are evaluating whether excessive activation of
glutamate (a brain chemical) may be reduced by blocking receptors of
N-methyl-D-aspartate (NMDA), a similar neurotransmitter, which may help to halt
abnormal nerve cell death. The drug under investigation is riluzole (Rilutek©),
which blocks activation of glutamate.
Another investigational drug for the symptomatic treatment
of HD is ethyl-EPA (Miraxion©). Miraxion© is eicosapentaenoic acid (EPA), a
component of omega-3 fatty acids or fish oils. Miraxion© seems to help decrease
the chorea (involuntary movements) that can be debilitating in individuals with
Nutrition and lifestyle changes: Proper diet and exercise is
very important for individuals with HD. As the disease progresses, persons with
HD may even choke. In helping individuals to eat, caregivers should allow
plenty of time for meals. Food can be cut into small pieces, softened, or
pureed to ease swallowing and prevent choking. While some foods may require the
addition of thickeners, other foods may need to be thinned. Dairy products, in
particular, tend to increase the secretion of mucus, which in turn increases
the risk of choking. It is best to avoid dairy products such as milk, cheese,
and sour cream.
Some individuals may benefit from swallowing therapy, which
is especially helpful if started before serious problems arise. Suction cups
for plates, special tableware designed for people with disabilities, and
plastic cups with tops can help prevent spilling. The individual's doctor can
offer additional advice about diet and about how to handle swallowing
difficulties or gastrointestinal problems that might arise, such as
incontinence or constipation.
Most HD sufferers need two to three times the calories than
the average person to maintain body weight. The normal population's average
daily intake is approximately 2,000 calories for women and 2,500 for children
and men. Caregivers should pay attention to proper nutrition so that the
individual with HD takes in enough calories to maintain his or her body weight.
Individuals with HD are at special risk for dehydration and therefore require
large quantities of fluids, especially during hot weather. Bendable straws can
make drinking easier for the person. In some cases, water may have to be
thickened with commercial additives to give it the consistency of syrup or
honey due to swallowing problems.
Exercise is extremely important for the person with HD to
maintain physical fitness as much as possible. Individuals with HD who exercise
and keep active tend to do better, with fewer symptoms and a slower disease
progression than those who do not. A daily regimen of exercise can help the
person feel better physically and mentally. Patients should walk as much as
possible, even if assistance is necessary.
Although their coordination may be poor, individuals should
continue walking, with assistance if necessary. Those who want to walk
independently should be allowed to do so as long as possible. Careful attention
should be given to keeping their environment free of hard, sharp objects to
help ensure maximal independence while minimizing the risk of injury from a
fall. Individuals can also wear special padding during walks to help protect
against injury from falls. Some individuals have found that small weights
around the ankles can help stability. Wearing sturdy shoes that fit well can
help too, especially shoes without laces that can be slipped on or off easily.
Speech therapy: HD can impair speech, affecting the ability
of the individual to express complex thoughts. Speech therapy may improve the
individual's ability to communicate and swallowing methods. It is important for
caregivers to understand that individuals with HD may not be communicating due
to the disease and not due to lack of sociability.
Social activity: Unless and until the disease's progression
prohibits it, people with HD should participate in outside activities,
socialize, and pursue hobbies and interests. These activities also give family
members and caregivers valuable time for themselves.
Caregiver support: Huntington's disease confronts
individuals and their caregivers with many complex problems that must be dealt
with for the life of the patient. While it may be emotionally difficult, it is
important for patients and caregivers to make informed, carefully considered
decisions regarding the future while the patient is capable of making his or
her contribution to a planned course of action. Patients and their family
members should discuss and consider issues such as legal concerns, home care,
assisted care, and institutionalization. Wills should be drawn up and legalized
and other important documents should be taken care of as early as possible to
avoid legal problems later on, when the patient may be unable to represent his
or her own interests. Legal assistance may be necessary
Part-time help with housekeeping and physical care is often
necessary. Federal, state, and local government programs and private agencies
provide varying levels of domestic assistance, nutritional and nursing care,
occupational therapy, and other home-based services. In some communities, group
housing facilities are available to persons who are alone and still
independent, though not fully capable of providing for all routine needs, such
as cooking and housekeeping. In these group residences, a resident attendant
takes care of meals, housekeeping services, social activities, and local
The decision to institutionalize or place a family member in
a congregate care facility can be enormously difficult. Professional counseling
may be needed to help families deal with this important life choice.
Physical therapy: According to the American Physical Therapy
Association, the goal of physical therapy or physiotherapy is to improve
mobility, restore function, reduce pain, and prevent further injury by using a
variety of methods, including exercises, stretches, traction, electrical
stimulation, and massage. Physical therapy has been reported useful in
Prognosis: HD usually runs its full terminal course in 10-30
years. It has been observed that the earlier in life the symptoms of HD appear,
the faster the disease progresses. The bedridden patient in the final stages of
HD often dies from complications such as heart failure or pneumonia. Juvenile
HD runs its course comparatively fast, with death typically occurring in about
Note: Although few clinical studies exist using integrative
therapies for the treatment of Huntington's disease (HD), there have been
studies in other neurological disorders that may present with similar symptoms
as HD. Listed below are integrative therapies that have been studied clinically
in various movement disorders.
Good scientific evidence:
5-HTP: 5-HTP is the precursor for serotonin. Serotonin is
the brain chemical associated with sleep, mood, movement, feeding, and
nervousness. Cerebellar ataxia results from the failure of part of the brain to
regulate body posture and limb movements. 5-HTP has been observed to have benefits
in some people who have difficulty standing or walking due to cerebellar
ataxia. However, current evidence is mixed. Further research is needed before a
strong conclusion can be drawn.
Avoid 5-HTP if allergic or hypersensitive to it. Signs of
allergy to 5-HTP may include rash, itching, or shortness of breath. Avoid with
eosinophilia syndromes, Down syndrome, or mitochondrial encephalomyopathy. Use
cautiously if taking antidepressant medications, 5-HTP receptor agonists,
carbidopa, phenobarbital, pindolol, reserpine, tramadol, or zolpidem. Use
cautiously with kidney insufficiency, HIV/AIDS (particularly HIV-1 infection),
epilepsy, or with a history of mental disorders. Avoid if pregnant or
Music therapy: Music therapy has been reported to improve
symptoms in people with Parkinson's disease. Modest improvements were seen in
symptoms including: motor coordination, speech intelligibility and vocal
intensity, bradykinesia (slow movement), emotional functions, activities of
daily living, and quality of life. Music therapy is generally known to be safe.
Zinc: Wilson's disease is an inherited disorder of copper
metabolism characterized by a failure of the liver to excrete copper, which
leads to its accumulation in the liver, brain, cornea, and kidney, with
resulting chronic degenerative changes. Early research suggests that zinc
treatment may be effective in the management of Wilson's disease. More
well-designed trials are needed to confirm these early results.
Zinc is generally considered safe when taken at the
recommended dosages. Avoid zinc chloride since studies have not been done on
its safety or effectiveness. While zinc appears safe during pregnancy in
amounts lower than the established upper intake level, caution should be used
since studies cannot rule out the possibility of harm to the fetus.
Unclear or conflicting scientific evidence:
Acupressure, Shiatsu: The practice of applying finger
pressure to specific acupoints (energy points) throughout the body has been
used in China since 2000 B.C. Shiatsu technique involves finger pressure at
acupoints and along body meridians (energy lines). It can incorporate palm
pressure, stretching, massaging, and other manual techniques. Shiatsu
practitioners commonly treat musculoskeletal and psychological conditions,
including neck/shoulder and lower back problems, arthritis, depression, and
anxiety. Acupressure may benefit several measures of severity of Parkinson's
disease. Preliminary clinical evidence from one small study with individuals
with facial spasms reported improvement when using Shiatsu acupressure. Further
study is needed before conclusion can be made.
Acupressure appears to be safe if self-administered or
administered by an experienced therapist. Serious, long-term complications have
not been reported, according to available scientific data. Hand nerve injury
and herpes zoster ("shingles") cases have been reported after shiatsu
massage. Forceful acupressure may cause bruising.
Acupuncture: Aucupuncture has been reported to help relieve
symptoms of some neurological disorders, including cerebral palsy, nerve
damage, Parkinson's disease (characterized by fine muscle coordination and
tremors), Tourette's syndrome (characterized by "tics"), and
trigeminal neuralgia. More trials need to be performed.
Needles must be sterile in order to avoid disease
transmission. Avoid with valvular heart disease, infections, bleeding
disorders, medical conditions of unknown origin, neurological disorders or if
taking anticoagulants. Avoid on areas that have received radiation therapy and
during pregnancy. Avoid electroacupuncture with irregular heartbeat or in
patients with pacemakers. Use cautiously with pulmonary disease (like asthma or
emphysema). Use cautiously in elderly or medically compromised patients,
diabetics or with a history of seizures.
Alexander technique: The Alexander technique is an educational
program that teaches movement patterns and postures with an aim to improve
coordination and balance, reduce tension, relieve pain, alleviate fatigue,
improve various medical conditions, and promote well-being. Preliminary
research suggests that Alexander technique instruction may improve fine and
gross movements and reduce depression in patients with Parkinson's disease.
Well-designed human trials are necessary.
Serious side effects have not been reported in the available
literature. It has been suggested that the technique may be less effective with
learning disabilities or mental illnesses. The Alexander technique has been
used safely in pregnant women.
Arginine: Arginine, or L-arginine, is considered a
semi-essential amino acid because although it is normally synthesized in
sufficient amounts by the body, supplementation is sometimes required.
Injections of arginine have been proposed to help manage adrenoleukodystrophy
(ALD), although most study results are inconclusive. Further research is needed
to evaluate the use of arginine in ALD and other neurological conditions.
Avoid if allergic to arginine. Avoid with a history of
stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use
cautiously if taking blood-thinners, blood pressure drugs, antidiabetic drugs,
or herbs or supplements with similar effects. Blood potassium levels should be
monitored. L-arginine may worsen symptoms of sickle cell disease.
Ashwagandha: Ashwagandha (Withania somnifera) is widely
cultivated in India and the Middle East for its medicinal properties, and it is
also found in parts of Africa. There is insufficient scientific evidence to
determine if ashwagandha is a safe and effective treatment for Parkinson's
Avoid if allergic or hypersensitive to ashwagandha products
or any of their ingredients. Dermatitis (allergic skin rash) was reported in
three of 42 patients in one ashwagandha trial. There are few reports of adverse
effects associated with ashwagandha, but there are few human trials using ashwagandha
and most do not report the doses or standardization/preparation used. Avoid
with peptic ulcer disease. Ashwagandha may cause abortions based on anecdotal
reports. Avoid if pregnant or breastfeeding.
Ayurveda: Ayurveda is a form of natural medicine that
originated in ancient India more than 5,000 years ago. Ayurveda is an
integrated system of techniques that uses diet, herbs, exercise, meditation,
yoga, and massage or bodywork to achieve optimal health. There is evidence that
the traditional herbal remedy Mucuna pruriens may improve symptoms in
Parkinson's disease and that it may offer advantages over conventional L-dopa
preparations in the long-term management of the disorder. More studies are
needed in this area.
Ayurvedic herbs should be used cautiously because they are
potent, and some constituents may be potentially toxic if taken in large
amounts or for a long time. Some herbs imported from India have been reported
to contain high levels of toxic metals. Ayurvedic herbs may interact with other
herbs, foods, and drugs. A qualified healthcare professional should be
consulted before taking.
Belladonna: Belladonna has been used for centuries to treat
many medical conditions. To date, human studies have shown a lack of benefit
from belladonna in treating autonomic nervous system disorders.
Avoid if allergic to belladonna or plants of the Solanaceae
(nightshade) family (bell peppers, potatoes, eggplants). Avoid with a history
of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive
heart failure, stomach ulcers, constipation, stomach acid reflux (serious
heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy,
fever, bowel obstruction, benign prostatic hypertrophy, urinary retention,
narrow angle glaucoma, psychotic illness, Sj©gren's syndrome, dry mouth,
neuromuscular disorders, (such as myasthenia gravis), or Down syndrome. Avoid
if pregnant or breastfeeding.
Chiropractic: Chiropractic is a healthcare discipline that
focuses on the relationship between musculoskeletal structure (primarily the
spine) and body function (as coordinated by the nervous system) and how this
relationship affects the preservation and restoration of health. Although there
is not enough reliable scientific evidence to conclude the effects of
chiropractic techniques in the management of Parkinson's disease, anecdotal
reports suggest a positive impact on fine muscle coordination in some
individuals. More clinical research is necessary.
Avoid with symptoms of vertebrobasilar vascular
insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with
agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue
after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific
data. Use extra caution during cervical adjustments. Use cautiously with acute
arthritis, conditions that cause decreased bone mineralization, brittle bone
disease, bone softening conditions, bleeding disorders, or migraines. Use
cautiously with a risk of tumors or cancers.
Choline: Data regarding the effectivenses of choline in the
treatment of Parkinson's disease is conflicting and inconclusive at this time.
Avoid if allergic/hypersensitive to choline, lecithin, or
phosphatidylcholine. Use cautiously with kidney or liver disorders or
trimethylaminuria. Use cautiously with a history of depression. If pregnant or
breastfeeding it seems generally safe to consume choline within the recommended
adequate intake (AI) parameters; supplementation outside of dietary intake is
usually not necessary if a healthy diet is consumed.
Chromium: Chromium is an essential trace element that exists
naturally in trivalent and hexavalent states. Chromium has been studied for its
protective benefits in Parkinson's disease and is included in antioxidant
multivitamins. However, there is lack of scientific evidence in humans in this
area. Additional research is needed.
Trivalent chromium appears to be safe because side effects
are rare or uncommon. However, hexavalent chromium may be poisonous. Avoid if
allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver
problems, weakened immune systems (such as HIV/AIDS patients or organ
transplant recipients), depression, Parkinson's disease, heart disease, and
stroke and in patients who are taking medications for these conditions. Use
cautiously if driving or operating machinery. Use cautiously if pregnant or
Coenzyme Q10: Coenzyme Q10, or CoQ10, is produced by the
human body and is necessary for the basic functioning of cells. There is
promising evidence to support the use of CoQ10 in the treatment of symptoms
associated with Friedrich's ataxia and Parkinson's disease. Better-designed
trials are needed to confirm early study results.
Allergic reactions have not been associated with Coenzyme
Q10 supplements, although rash and itching have been reported rarely. Stop use
two weeks before and immediately after surgery/dental/diagnostic procedures
with bleeding risks. Use cautiously with a history of blood clots, diabetes,
high blood pressure, heart attack, or stroke, or if taking anticoagulants
(blood thinners) or antiplatelet drugs, blood pressure drugs, blood sugar
drgus, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.
Cowhage: Cowhage (Mucuna pruriens) seeds have been used in
traditional Ayurvedic medicine to treat Parkinson's disease. Traditional
Ayurvedic medicine and preliminary evidence suggests that cowhage contains
3.6-4.2% levodopa, the same chemical used in several Parkinson's disease drugs.
Cowhage treatments have yielded positive results in early studies. However,
more research should be conducted to determine the treatment that is most
Avoid if allergic or hypersensitive to cowhage (Mucuna
pruriens), its constituents, or members of the Fabaceae family. Avoid with
psychosis or schizophrenia. Use cautiously with diabetes or Parkinson's disease
or if taking levodopa, dopamine, dopamine agonists, dopamine antagonists, or
dopamine reuptake inhibitors. Use cautiously if taking monoamine oxidase
inhibitors (MAOIs) or other antidepressants or anticoagulants (blood thinners).
Avoid if pregnant or breastfeeding, as cowhage may inhibit prolactin secretion.
Creatine: There is currently not enough scientific
information to make a firm conclusion about the use of creatine in Huntington's
disease. High-quality studies are needed to clarify this relationship.
Numerous studies suggest that creatine may help treat
various neuromuscular diseases and may delay the onset of symptoms when used
with standard treatment. However, creatine ingestion does not appear to have a
significant effect on muscle creatine stores or high-intensity exercise
capacity in individuals with multiple sclerosis, and supplementation does not
seem to help people with tetraplegia. Although early studies were encouraging,
recent research reports no beneficial effects on survival or disease
progression. Additional studies are needed to provide clearer answers.
It is unclear if creatine is helpful in patients with spinal
cord injuries. Results from early studies have been mixed. Further studies are
required before a firm conclusion can be made.
Avoid if allergic to creatine or if taking diuretics. Use
cautiously with asthma, diabetes, gout, kidney disorders, liver or muscle
problems, stroke, or with a history of these conditions. Avoid dehydration.
Avoid if pregnant or breastfeeding.
DHEA: There is conflicting scientific evidence regarding the
use of DHEA (dehydroepiandrosterone) supplements for myotonic dystrophy. Better
research is necessary before a clear conclusion can be drawn.
Avoid if allergic to DHEA. Avoid with a history of seizures.
Use cautiously with adrenal or thyroid disorders or if taking anticoagulants or
drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke.
Stop use two weeks before and immediately after surgery/dental/diagnostic
procedures with bleeding risks. Avoid if pregnant or breastfeeding.
Dong quai: Dong quai (Angelica sinensis), also known as
Chinese Angelica, has been used for thousands of years in traditional Chinese,
Korean, and Japanese medicine. There is insufficient evidence to support the
use of Dong quai as a treatment for nerve pain. High-quality human research is
Although Dong quai is accepted as being safe as a food
additive in the United States and Europe, its safety in medicinal doses is
unknown. Long-term studies of side effects are lacking. Avoid if
allergic/hypersensitive to Dong quai or members of the Apiaceae/Umbelliferae
family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged
exposure to sunlight or ultraviolet light. Use cautiously with bleeding
disorders or if taking drugs that may increase the risk of bleeding. Use
cautiously with diabetes, glucose intolerance, or hormone-sensitive conditions
(like breast cancer, uterine cancer, or ovarian cancer). Do not use before
dental or surgical procedures. Avoid if pregnant or breastfeeding.
Feldenkrais Method©: The Feldenkrais Method© involves
stretching, reaching, and changing posture in specific patterns. In some cases,
it includes a form of massage. Patients who practice complementary alternative
medicine methods have reported that the Feldenkrais Method©, as well as
breathing therapy, massage, and relaxation techniques, helped improve symptoms
of dystonia. Further data are needed before a firm conclusion can be made.
There is currently not enough clinical evidence to determine if the Feldenkrais
Method© is an effective treatment for cerebral palsy.
There is currently a lack of available scientific studies or
reports of safety of the Feldenkrais Method©.
Ginseng: A clinical study found that patients with
neurological disorders may improve when taking Asian ginseng (Panax ginseng).
This supports research findings that report Panax ginseng improving cognitive
function. More research is needed in this area.
Avoid with known allergy to plants in the Araliaceae family.
There has been a report of a serious life-threatening skin reaction, possibly
caused by contaminants in ginseng formulations.
Kava: Kava beverages, made from dried roots of the shrub
Piper methysticum, have been used ceremonially and socially in the South
Pacific for hundreds of years and in Europe since the 1700s. There is currently
unclear evidence on the use of kava for Parkinson's disease. Kava has been
shown to increase 'off' periods in Parkinson's patients taking levodopa and can
cause a semicomatose state when given with alprazolam. Consult with a qualified
healthcare professional before taking kava due to the risk of harmful side
Avoid if allergic to kava or kavapyrones. Avoid with liver
disease, a history of medication-induced extrapyramidal (the motor system
related to the basal ganglia) effects, and chronic lung disease. Avoid if
taking medications for liver disease or CNS depressants such as alcohol or
tranquilizers. Avoid while driving or operating heavy machinery (may cause
drowsiness). Use cautiously with depression or if taking antidpressants. Avoid
if pregnant or breastfeeding.
L-carnitine: Although used traditionally for support of
neurological conditions, one poorly designed preliminary clinical study
reported that L-acetyl-carnitine (carnitine or L-carnitine) possesses neither
efficacy nor toxicity towards the patients with Huntington disease. Further
trials are required to determine is L-carnitine is beneficial in individuals
with neurological disorders.
Early research on the use of carnitine for Rett's syndrome
has produced promising results. However, additional research is needed before a
firm conclusion can be made.
Avoid with known allergy or hypersensitivity to carnitine.
Use cautiously with peripheral vascular disease, high blood pressure,
alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low birth
weight infants and individuals on hemodialysis. Use cautiously if taking
anticoagulants (blood thinners), beta-blockers, or calcium channel blockers.
Avoid if pregnant or breastfeeding.
Massage: Early evidence suggests a possible benefit of
massage for cerebral palsy, Parkinson's disease, and spinal cord injuries.
However, evidence is insufficient on which to base recommendations.
Avoid with bleeding disorders, low platelet counts, or if
taking blood-thinning medications (such as heparin or warfarin/Coumadin©).
Areas should not be massaged where there are fractures, weakened bones from
osteoporosis or cancer, open/healing skin wounds, skin infections, recent
surgery, or blood clots. Use cautiously with a history of physical abuse or if
pregnant or breastfeeding. Massage should not be used as a substitute for more
proven therapies for medical conditions. Massage should not cause pain to the
Melatonin: Melatonin is a naturally occurring hormone that
helps regulate sleep/wake cycles (circadian rhythm). Melatonin has been
reported useful in neurological conditions including Parkinson's disease,
periodic limb movement disorder, Rett's syndrome, and tardive dyskinesia
(abnormal movements that can occur after long-term use of some older
antipsychotic drugs). The use of melatonin in these conditions, however, is not
supported by rigorous scientific testing. Better-designed research is needed to
determine if melatonin is beneficial in individuals with neurological
Avoid melatonin supplementation in women who are pregnant or
attempting to become pregnant. Use cautiously with bleeding disorders, seizure
disorders, or if taking anticoagulants.
Moxibustion: Moxibustion uses the principle of heat to
stimulate circulation and break up congestion or stagnation of blood and chi
(energy). One small study reported treatment of trigeminal neuralgia with
cupping to have a significant therapeutic effect. However, there is
insufficient available evidence and more clinical studies are needed in this
Avoid with aneurysms, any kind of "heat syndrome,"
heart disease, convulsions or cramps, diabetic neuropathy, extreme fatigue
and/or anemia, fever, or inflammatory conditions. Avoid areas with an inflamed
organ, contraindicated acupuncture points, allergic skin conditions, ulcerated
sores, or skin adhesions. Avoid over the face, genitals, head, or nipples.
Avoid in patients who have just finished exercising or taking a hot bath or
shower. Avoid if pregnant or breastfeeding. Use cautiously over large blood
vessels and thin or weak skin. Use cautiously with elderly people with large
vessels. It is considered not advisable to bathe or shower for up to 24 hours
after a moxibustion treatment.
Physical therapy: There is evidence for the use of physical
therapy for nerve or neurological disorders such as cerebral palsy,
Guillain-Barre Syndrome (GBS), and Parkinson's disease. Additional high-quality
studies are needed.
Not all physical therapy programs are suited for everyone,
and patients should discuss their medical history with their qualified
healthcare professionals before beginning any treatments. Physical therapy may
aggravate pre-existing conditions. Persistent pain and fractures of unknown
origin have been reported. Physical therapy may increase the duration of pain
or cause limitation of motion. Pain and anxiety may occur during the
rehabilitation of patients with burns. Both morning stiffness and bone erosion
have been reported in the literature, although causality is unclear. Erectile
dysfunction has also been reported. Physical therapy has been used in
pregnancy, and although reports of major adverse effects are lacking in the
available literature, caution is advised nonetheless. All therapies during
pregnancy and breastfeeding should be discussed with a licensed
obstetrician/gynecologist before initiation.
Psychotherapy: Psychotherapy is an interactive process
between a person and a qualified mental health professional. The patient
explores thoughts, feelings, and behaviors to help with problem solving.
Supportive psychotherapy may or may not reduce the motor and vocal tics
associated with Tourette's syndrome. More research needs to be done before
conclusions can be made. Some forms of psychotherapy may evoke strong emotional
feelings and expression.
Qi gong: Qi gong is a type of traditional Chinese medicine
(TCM) that is thought to be at least 4,000 years old. It is traditionally used
for spiritual enlightenment, medical care, and self-defense. There is promising
early evidence suggesting that internal Qi gong may help in the treatment of
Parkinson's disease. However, the evidence is somewhat unclear, and further
research is needed.
Qi gong is generally considered to be safe in most people
when learned from a qualified instructor. Use cautiously with psychiatric
Reiki: Reiki is a system of laying on of the hands that
originated in as a Buddhist practice approximately 2,500 years ago. Human study
suggests that reiki may have an effect on autonomic nervous system functions
such as heart rate, blood pressure, or breathing activity, important in
neurological disorders that may damage autonomic function, including
neurological conditions. Large, well-designed studies are needed before
conclusions can be drawn.
Reiki is not recommended as the sole treatment approach for
potentially serious medical conditions and should not delay the time it takes
to consult with a healthcare professional or receive established therapies. Use
cautiously with psychiatric illnesses.
Rolfing© Structural Integration:Rolfing© Structural
Integration involves deep tissue massage aimed at relieving stress and
improving mobility, posture, balance, muscle function and efficiency, energy,
and overall well being. Rolfing© Structural Integration may slightly improve
movement in cerebral palsy patients. More studies are needed to confirm these
Rolfing© Structural Integration should not be used as the
sole therapeutic approach to disease, and it should not delay the time it takes
to speak with a healthcare provider about a potentially severe condition.
Rolfing© Structural Integration is generally believed to be safe in most
people. Avoid in patients taking blood thinners and in patients with broken
bones, severe osteoporosis, disease of the spine or vertebral disks, skin
damage or wounds, bleeding disorders, blood clots, tooth abscesses, acute disc
problems, aneurysm, fever, recent scar tissue, connective tissue disease,
cancer, and in patients who have just received cortisone shots or who are on
chronic cortisone therapy. Use cautiously in patients with varicose veins or
phlebitis, joint diseases, psychosis or bipolar disorder, severe kidney, liver,
or intestinal disease, diabetes, menstruation, infectious conditions,
colostomies, high blood pressure, and stenoses or strictures.
Safflower: In clinical research, safflower (Carthamus
tinctoria) decreased deterioration caused by Friedreich's ataxia. More
high-quality studies with larger sample sizes are needed to establish
safflower's effect on neurological conditions.
Avoid if allergic/hypersensitive to safflower, Carthamus
tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any
related constituents. Use parenteral safflower oil emulsions cautiously in
newborns. Use cautiously if taking anticoagulants (blood thinners) or
anti-platelet drugs, immunodepressants or pentobarbital. Use cautiously with
diabetes, low blood pressure, liver problems, bleeding disorders, or skin
pigmentation conditions. Use cautiously if pregnant or breastfeeding.
Selenium: Studies have consistently shown that antioxidants
may not have clinical benefits in motor neuron diseases, such as amyotrophic
lateral sclerosis (ALS). Although the research thus far does not discourage
selenium supplementation in patients, more research is needed to determine if
selenium is an effective treatment for central nervous system disorders.
Avoid if allergic or sensitive to products containing
selenium. Avoid with a history of non-melanoma skin cancer. Selenium is
generally regarded as safe for pregnant or breastfeeding women. However, animal
research reports that large doses of selenium may lead to birth defects.
Tai chi: Tai chi is a system of movements and positions
believed to have developed in 12th Century China. Tai chi techniques aim to
address the body and mind as an interconnected system and are traditionally
believed to have mental and physical health benefits to improve posture,
balance, flexibility, and strength. Community-based fitness programs, which
include tai chi classes, may improve balance in patients with Parkinson's
disease and may motivate individuals to participate in routine exercise.
Additional research is warranted in this area.
Avoid with severe osteoporosis or joint problems, acute back
pain, sprains, or fractures. Avoid during active infections, right after a
meal, or when very tired. Some believe that visualization of energy flow below
the waist during menstruation may increase menstrual bleeding. Straining
downwards or holding low postures should be avoided during pregnancy, and by
people with inguinal hernias. Some tai chi practitioners believe that
practicing for too long or using too much intention may direct the flow of chi
(qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi
should not be used as a substitute for more proven therapies for potentially
serious conditions. Advancing too quickly while studying tai chi may increase
the risk of injury.
Taurine: Taurine may affect cellular hyperexcitability by
increasing membrane conductance to potassium and chloride ions, possibly by
altering intracellular (within the cell) availability of calcium. Study results
suggest that taurine supplementation may result in improvements in myotonic
dystrophy. Well designed clinical trials are needed.
Taurine is an amino acid, and it is unlikely that there are
allergies related to this constituent. However, allergies may occur from
multi-ingredient products that contain taurine. Use cautiously in patients with
high cholesterol, low blood pressure, bleeding disorders, potential for mania,
or epilepsy. Avoid consuming energy drinks containing taurine, caffeine,
glucuronolactone, B vitamins, and other ingredients before drinking alcohol or
exercising. Use cautiously if pregnant or breastfeeding because taurine is a
natural component of breast milk.
TENS: Transcutaneous electrical nerve stimulation (TENS) is
a non-invasive technique in which a low-voltage electrical current is delivered
through wires from a small power unit to electrodes located on the skin.
Electrodes are temporarily attached with paste in various patterns, depending
on the specific condition and treatment goals. Several studies have reported
benefits of TENS therapy in patients with trigyminal neuralgia (facial pain),
hemiplegia/hemiparesis, and spinal cord injury. Additional research is needed
before a firm conclusion can be drawn.
Avoid with implantable devices, such as defibrillators,
pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use
cautiously with decreased sensation (such as neuropathy) or with seizure
disorders. Avoid if pregnant or breastfeeding.
Therapeutic touch: Therapeutic touch (TT) practitioners hold
their hands a short distance from the patient without actually making physical
contact. The purpose of this technique is to detect the patient's energy field,
allowing the TT practitioner to correct any perceived imbalances. There is some
evidence that therapeutic touch may affect some properties of the central
nervous system. However, further research is needed to examine whether
therapeutic touch could have any effects on central nervous system disorders.
Therapeutic touch is believed to be safe for most people.
Therapeutic touch should not be used for potentially serious conditions in
place of more proven therapies. Avoid with fever or inflammation and on body
areas with cancer.
Vitamin B6: Vitamin B6 (pyridoxine) is required for the
synthesis of the neurotransmitters serotonin and norepinephrine and for myelin
formation. Pyridoxine deficiency in adults principally affects the peripheral
nerves, skin, mucous membranes, and the blood cell system. In children, the
central nervous system (CNS) is also affected. Major sources of vitamin B6
include cereal grains, legumes, vegetables (carrots, spinach, and peas),
potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Some prescription
drugs called neuroleptics, which are used in psychiatric conditions, may cause
movement disorders as an unwanted side effect. Vitamin B6 has been studied for
the treatment of acute neuroleptic-induced akathisia (NIA, a neuromuscular
disorder characterized by a feeling of "inner restlessness" or a
constant urge to be moving) in schizophrenic and schizoaffective disorder
patients. Preliminary results indicate that high doses of vitamin B6 may be
useful additions to the available treatments for NIA, perhaps due to its
combined effects on various neurotransmitter systems. Further research is
needed to confirm these results.
There is also early evidence that pyridoxine supplementation
may be of benefit in hyperkinetic cerebral dysfunction syndrome and tardive
dyskinesia. Further research is needed before a recommendation can be made.
Vitamin B6 is likely safe when used orally in doses not
exceeding the recommended dietary allowance (RDA). Avoid vitamin B6 products if
sensitive or allergic to any of their ingredients. Some individuals seem to be
particularly sensitive to vitamin B6 and may have problems at lower doses.
Avoid excessive dosing. Use cautiously if pregnant or breastfeeding.
Vitamin E: Vitamin E has been studied in the management of
tardive dyskinesia (abnormal movements that can occur after long-term use of
some older antipsychotic drugs) and Parkinson's disease, although the results
of existing studies are not conclusive enough to form a clear recommendation.
More research is needed.
Avoid if allergic or hypersensitive to vitamin E. Avoid with
retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding
disorders or if taking blood thinners. Avoid doses greater than the recommended
daily level in pregnant women and breastfeeding women.
Yohimbe bark extract: The terms yohimbine, yohimbine
hydrochloride, and yohimbe bark extract are related but not interchangeable.
Yohimbine is an active chemical (indole alkaloid) found in the bark of the
Pausinystalia yohimbe tree. Yohimbine hydrochloride is a standardized form of
yohimbine that is available as a prescription drug in the United States. It is
theorized that yohimbine may improve orthostatic hypotension (lowering of blood
pressure with standing) or other symptoms of autonomic nervous system dysfunction.
However, yohimbe bark extract may not contain significant amounts of yohimbine,
and therefore may not have these proposed effects. More research is needed
before a recommendation can be made.
Copyright © 2011
Natural Standard (www.naturalstandard.com)