Parkinsonian Links

More forms of therapy

It may be unfair to group other forms of therapy together like this, because they may all have value and we don't want to suggest to the contrary. But when one goes through the literature, one sees references to other therapies - therapies that are tested and written up and peer reviewed, but not in general use. And why not? Possibly because it takes time for the "establishment" to accept them, possibly because they are not considered to be cost-effective, possibly because the patients are suspicious of anything that is not mainstream.

In any event, here are several other forms of therapy with a discussion on each:

  • Yoga
  • Magnetic Stimulation
  • Dancing

    • Yoga. There is a yoga group specifically for people with Parkinson's, meeting at Northwestern University in Chicago. There may be more such groups, but I have yet to identify them.

    This article, which was written by Bette McDevitt, appeared in the Pittsburgh, Pennsylvania, Post-Gazette on 28 October, 2004. It is one of many articles that an internet search would turn up.


    Yoga eases Parkinson's symptoms for some.

    Robert Moser and Italo Melocchi walk side by side, each slowly lifting a leg, placing the heel down, then the toe. They make this walk on a wood floor, facing a mirror, moving together in a friendship forged by the affliction they share, Parkinson's disease. Melocchi, 72, of Churchill, is a retired carpenter and a skilled woodworker. Moser, 61, of Shadyside, is the owner of Arthur Moser Design Studios. They met while taking yoga classes at Shadyside Yoga, and are there to restore their well-being.

    Parkinson's disease, a degenerative disorder of the nervous system, is characterized by a decrease in spontaneous movements, gait difficulty, muscle rigidity and tremors when the body is at rest.

    Yoga's slow movements and breathing exercises are well suited to Parkinson's patients, the teachers say.

    "You don't have to turn into a pretzel to do yoga," says one of the instructors, Paul Hajdukiewicz. "The breath... is actually the most powerful tool. We simply need to attach our awareness to our breath, and that opens up all kinds of possibilities."

    Researchers at the University of Pittsburgh and at other centers across the country are beginning to examine exercise as a way to either slow or reverse the effects of Parkinson's. Most of the research so far has been done on animals.

    But at least anecdotally, Parkinson's patients taking classes at Shadyside Yoga and elsewhere say they experience improved energy and flexibility, more restful sleep, and more strength and endurance.

    Melocchi, who was diagnosed in 1994, and Moser in 1997, have taken yoga for three years while continuing to take their medication. Melocchi saw improvement within two to three months in increased flexibility and movement and less fatigue. Rigidity decreased as well.

    Moser experienced immediate improvement. "I could move my legs when they were frozen," he said. It also brightened his mental outlook, but he still acknowledges that he is still pretty angry about being afflicted "with this horrible disease."

    Sara Azarius, founder of Shadyside Yoga, sees a lot of frustration in Parkinson's patients and believes the yoga helps ease that feeling. "They have determination, but they have a lot of anger and anxiety."

    To achieve the greatest benefit, students are urged to take breathing (pranayama) and posture (asana) classes, to work with instructors one on one, and to practice at home.

    "Parkinson's patients tend to be very goal oriented, they cannot slow down, and so they fight hard and do not rest enough," she says. "They need pre-emptive deep resting, and the breathing exercises do a lot of that."

    Shadyside Yoga offers Iyengar style hatha yoga, a precise and disciplined method that can provide therapeutic benefits for physical problems and sports injuries.

    In the classes, the teachers start with the basics.

    "I make them walk very slowly holding on to the bar or the wall, The slower they go the more they wobble, but that's the way they develop balance," Azarius says.

    "Just to walk is a very intricate process, a highly coordinated activity. If you watch a child, they don't do it overnight. They learn it piece by piece."

    Moser said his doctors are enthusiastic about his yoga practice. "I go as often as seven days or as little as two," he said. "I wasn't breathing before. I don't know what the hell I was doing, but I wasn't breathing."

    He had been exercising with free weights and on a treadmill at a local health club when a friend invited him to go to a yoga class with her. He continues to strength train as part of his therapy. Melocchi has developed a stuttering problem with his Parkinson's disease. When the words come tumbling out, Azarius stops him with one word. "Inhale!" If he inhales, pauses, then exhales, he easily completes the sentence without stuttering.

    The benefits of yoga are hard to measure beyond anecdotal assessments. Dr. Timothy McCall, medical editor of Yoga Journal, and a yoga student, spent several months in India to reconcile the science of medicine and yoga.

    "...It is enough to drive a Western scientist crazy. With dozens of major styles of yoga, hundreds of individual practices and the variations on these techniques used with individual students and in different systems, there are simply more combinations of possible treatments than it will ever be possible to sort out experimentally," McCall wrote in Yoga Journal.

    "There is a lot of research on yoga and most of it suggests yoga works for a wide variety of conditions from back pain to cancer to carpal tunnel syndrome. What we don't know is which elements of the practice works, whether it is some particular poses or breathing techniques or the combination of dozens of them."

    Looking at yoga scientifically raises other concerns, McCall says.

    "Some view this 'medicalization' of yoga as a problem; they worry that doing yoga for a bodily affliction trivializes this great spiritual tradition."

    Azarius has no equivocation in her response.

    "If a Parkinson's patient takes a class, and reports that he or she feels better after a class, they know how they feel. So let the scientists who want to spend their time proving and disproving things do that. But as a yoga teacher, I want to spend my time helping someone."




    This is a broadcast transcript from Ivanhoe with Mikhail Lomarev, Ph.D., M.D., is a Neurologist with National Institutes of Health, Bethesda, Maryland.

    TOPIC: Magnetic Stimulation for Parkinson's

    What are the symptoms of Parkinson's disease?

    Dr. Lomarev: Some areas of the brain are under-activated in patients with Parkinson's disease, which causes a slowness of motions, tremors or shaking, and postural instability. The combination of these four symptoms is what a Parkinson's patient experiences. There could also be depression or dementia, but those are the four main features.

    And, medications are designed to do what?

    Dr. Lomarev: The current medications are evolving around dopamine, which functions as a neurotransmitter in the brain. Parkinson's disease causes the level of dopamine in the brain to decrease and this causes all of the symptoms. So, the medication for Parkinson's is aimed at substituting that deficit of dopamine.

    The problem with the drugs used to treat Parkinson's is that they have a lot of side effects. Actually, 50 percent of patients after about five years of treatment have motor complications and involuntary movements. So, from the point of view of giving more benefit to the patient, it's better to give more medication, but in terms of avoiding complications in the long-run the medication dosage needs to be decreased.

    Do people build up a tolerance to these medications?

    Dr. Lomarev: Well, in the beginning people tolerate them not too badly, but after five years of treatment with a lot of dopamine drugs, for example, 50 percent of patients have multiple complications. That's why we are trying to do something with transcranial magnetic stimulation to reduce the doses of dopamine.

    What is transcranial magnetic stimulation?

    Dr. Lomarev: The transcranial magnetic stimulation uses a machine, or a generator, which has a lot of condensers. The condensers are charges and they discharge the electricity through a coil, which is basically a conductor. The current flows through the coil, and around the surface of the coil a magnetic field is generated. The sequence of the events is actually here: TMS machine, TMS coil, and magnetic field in the brain that penetrates through this coil. The electrical current is induced in different layers of the motor cortex and activation of the brain is a result of this kind of stimulation.

    What we are trying to do here with TMS is make the patient's brain more sensitive to the medication he or she is already taking. When you stimulate this area in supplementary motor, part of the prefrontal area and the striatum are activated as well, which is where there is a decrease in the level of dopamine for Parkinson's patients. So, TMS could be an enhancement and something complimentary to the medications the majority of the patients take in this country.

    And, this has been used for years in depression patients?

    Dr. Lomarev: Yes. It has widely been used for depression for more than 10 years, I think.

    Is that how you knew it was safe?

    Dr. Lomarev: Oh, yes. The safety limits were established like 10 years, probably even 15 years ago.

    At this point, what makes you think that TMS is effective? I know that with the study that's currently underway you don't know the results, but you have previous studies you've done, correct?

    Dr. Lomarev: As I said, our goal is to improve stiffness in patients to make them move faster than they did before. So, what we have done is tested the patient with a couple of motor tests to begin with. One of these tests was walking along the corridor, and we measured the time which was needed to walk a 10-meter distance. If you were to look at our tracking graph, you would be able to see that the red line goes down, which means that over the period of two weeks during which I gave up to eight TMS session, patients regularly walked faster and faster. The factors were all the same throughout the tests: the same distance, the same corridor, and the same amount of dopamine medication, which is the important part. And, it looks like this is not a therapeutic effect because in the other group, which was the placebo group, the same number of patients was tested in the same conditions, but the blue line is more or less parallel to the horizontal access. So, there was no improvement in the placebo group. The other test we have done is the combined movement test. What we ask patients to do is the combination of two movements like flexion extension in two joints because this is difficult for a Parkinson's patient to do. And, again imagine the graph, and again you can see that the red line goes down over the same period of eight TMS sessions. And, the blue line is more or less parallel to the axis which means that there is no placebo effect. Hopefully, this means there is a real biological effect of the magnetic stimulation.

    What do you hope the outcome of the study that you're currently running will be?

    Dr. Lomarev: I want to emphasize that we are somewhere in the beginning of this pretty long week. We are going to compare three different methods of treatment. One of them I told you about already. The second one will be the stimulation of the brain with a very mild, direct current applied to the head of the patient, or DC stimulation as it is called in German literature. So, we will compare the TMS we are doing now with the DC stimulation we will be doing next year. Then we will go to high frequency magnetic stimulations with another type of coil. Then we will compare those three and depending on which one of those three is better, we'll work with that method.

    How often do patients receive transcranial magnetic stimulation as a treatment to depression?

    Dr. Lomarev: There are different protocols. Some of them are doing it every day, others using it not so often.

    Interesting. So, one day with Parkinson's you would expect people to come to their doctor's office and have TMS frequently, like what happens now with depression patients?

    Dr. Lomarev: Well, this is a very interesting question. It is different with depression; people are doing ECT, or electric convulsive therapy. Some of them think that ECT is better; definitely it is faster than the TMS because TMS is time consuming. But at least people are using TMS to treat depression in Canada. In Canada, the TMS is approved for clinical use, not for the research use only. So, there is some future in this method.

    Only time will tell?

    Dr. Lomarev: Oh, of course. Only time will tell.

    The above article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week.


    Dancing

    Here ae several places where dancing and Parkinson's are discussed:

  • This links to an article from the World Parkinson Disease Association (WPDA).
  • " Dancing is excellent exercise. The Parkinson patient moves nicely to music. You don't have to be a "good" dancer to enjoy this activity and it is really fun to see the reaction of friends when they see you on the dance floor. A Parkinson patient can do as well as a healthy person in this area." - From Practical Pointers for Parkinsons (NPF)


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    Revised 21 March, 2004