NCF Blog

Chiropractic for Parkinson’s? Be Cautious.

Many patients are interested alternative therapy for medical diseases, with at least 80% of adults taking some form of vitamins, herbal preparations, acupuncture, biofeedback, Tai Chi, Yoga, etc. With regard to PD, data from small studies show that PD patients have improvement in sense of well-being and stiffness with both Tai Chi and Yoga, but no changes in motor performance. Data regarding chiropractic treatment for PD has not been available or reliable.
My approach to PD has always been “as long as it will not hurt you, it’s probably okay, as long as you don’t use it as your sole method of treatment.” By “hurt you” I mean physical damage or injury, worsening of PD, significant pain, or mental/psychological damage. I would include giving false hope or making unfounded claims as being harmful to patients, emotionally, financially, and often physically.
There are clearly some well-educated, conservative chiropracters who offer treatments locally for a variety of well-established conditions. As long as PD patients are aware that there is no good scientific evidence either way regarding effectiveness for PD and they look carefully at what is being offered or claimed by the chiropracter, then they may choose to try it.
Of particular concern, however, is when fantastical, non-scientific claims are being made. These can be found locally as well as nationally. I would caution patients to avoid some treatments in particular, especially those that are invasive. “Functional Cranial Release,” for instance, is a non-scientific and somewhat risky procedure that is being touted as a treatment for just about everything, including PD. It involves a balloon being inserted into the nasal passages, then expanded, then contracted and removed, with claims that it is restoring or correcting cranial abnormalities. It is further claimed that this procedure treats Alzheimer’s, headaches, migraines, ringing in the ears, fibromyalgia, and the list goes on and on. The purported mechanism of patient improvement is by “improving blood flow and oxygenation” to the brain and “releasing nerves.” Patients are reportedly dramatically improved and, sometimes, told they can stop taking their medications. Nasal damage has been clearly documented in some patients who underwent this procedure.
This meets the classic criteria for a scam: unproven claims, lack of scientific evidence, miraculous reversal of degenerative processes, panacea (good for anything), aggressive marketing with glowing testimonials, lack of anatomical/physiological basis in reality. See http://www.quackwatch.com/
To summarize, patients should not avoid chiropracters as a group, but, just as in any profession, there are a few practitioners and treatments who should be avoided at all cost.

The benefits of coffee and caffeine in Parkinson Disease have been explored more and more these days.  It has been known for 10 years or more that caffeine seems to lower the risk of getting PD in the first place, but there are some populations who benefit from it even more due to a gene that helps lower risk in the coffee drinker.  The mechanism appears to be via the adenosine system; caffeine inhibits the adenosine A2A receptor, which has further effects inside of brain cells.  An additional benefit of coffee for PD patients is that, of course, it reduces the sleepiness during the daytime which bothers many PD patients.  The apparent therapeutic effects are significant enough that several pharmaceutical companies are trying to develop caffeine-related molecules and there are National Institutes of Health (USA) approved studies currently underway.  See links below:

http://www.physorg.com/news/2011-09-coffee-key-ingredient-treatments-parkinson.html

http://www.google.com/search?client=safari&rls=en&q=caffeine+parkinson’s+disease&ie=UTF-8&oe=UTF-8

Usually, people don’t think of Parkinson Disease as being related to blood flow, or lack of blood flow, to the brain.  However, neurologists have known for a very long time that small strokes in the brain can cause walking and balance problems which may mimic PD.  This condition is known as Parkinsonism.  The blockage of hundreds or thousands of tiny blood vessels builds up slowly over time and causes dysfunction or death of brain cells.  These are akin to “silent” strokes; the person afflicted with them is never aware of any particular event.  The end result is slow movement, poor balance, shuffling gait, slow thinking, memory loss.  Sound familiar?

We also know that any degenerative neurological condition, such as Alzheimer Disease, Parkinson Disease, or Huntington Disease, seems to progress more rapidly if there is also blockage of the small blood vessels as mentioned above.  This is partly the basis for encouraging exercise in people at risk for such diseases.  We believe, and studies seem to support, that control of cardiovascular risk factors (high blood pressure, high cholesterol, diabetes) delays the onset and severity of neurological disease, especially in the case of Alzheimer Disease.

In an important new study  published in the journal Stroke: Journal of the American Heart Association, researchers from Rush University Medical Center in Chicago, showed that, even in people with seemingly normal brain scans (MRI or CT), there may be small blood vessel blockages seen in the brain at the time of autopsy.  Furthermore, they correlated the severity of walking problems with the severity of the blockages.  Up to 30% of people with normal brain scans had abnormal blood vessels on autopsy.  The implication is that slow movements, decreased balance, and walking abnormalities may not be “normal aging.”   This is similar to what we see with memory loss in the elderly; dementia used to be considered normal aging, but we now know that anything beyond mild memory loss suggests that there is an abnormal process occurring in the brain, such as Alzheimer Disease or other problems.

The main point is that we all need to take care of our cardiovascular health through proper diet, exercise, and getting treated for any hypertension, diabetes, or cholesterol problems.

Neuro Challenge Foundation’s Annual Parkinson Gala, “Cause 4 Fashion” is nominated for The Longboat Observer’s “Standout Event” Award for 2010-11. To win, WE NEED YOU TO VOTE. Here are the directions:

To go to The Observer’s website, click here.

1. Login or Register (the first time you have to register with minimal information required). To follow the steps below, you might have to scroll down depending on your monitor and browser.

2. Click “vote” on the bar.

3. Click “Standout Event” on the bar.

4. Click the radio button under “Cause 4 Fashion.”

5. Click the “Submit” button.

6. Repeat steps 4 & 5 nine more times.

7. Do this everyday until the end of September.

8. Join the fun at The Observer Group’s “Black Tie Bash” where the winners will be honored. Black Tie Bash benefits The Community Foundation of Sarasota “Season of Sharing.” Get your party on!

SAVE THE DATE FOR CAUSE 4 FASHION — THE PARKINSON’S GALA

MARCH 1, 2012

This is a common question that comes up in the neurologists’ office, regardless of age of the patient.  It arises not just from concern for family members, but also as a matter of curiosity, of explanation.

We used to believe that Parkinson Disease was almost entirely caused by environmental factors.  20 years ago, genetic involvement was deemed to be around 2% of cases or less.  Through the advent of advanced and increasingly affordable genetic testing, as well as improved collaboration across the globe, we now believe that genes account for at least 8% of PD, perhaps up to 15% based on more recent data.  People with Young Onset Parkinson Disease, those with dystonia early on, and those with symmetric (both sides) findings are probably more likely to have a genetic cause than the more typical patients.

Yes, some environmental factors have been linked to increased risk of PD, such as pesticides, herbicides, fungicides, some heavy metals, and, perhaps, living in North America, but the linkage or direct cause is not as obvious as one might hope.  To date, the use of surveys and questionnaires has produced few, if any, clues to the causes of PD.

The virtual revolution that has occurred in genetic testing in the past 20-odd years has allowed us to identify quite a few genes that seem to cause PD, perhaps 15 or 20 genes that are under study, with more being identified at an increasing rate.  In a recent interview with Medscape Medical News, Owen A. Ross, PhD, a neuroscientist at the Mayo Clinic said ”The idea that [PD] occurs mostly in a random sporadic fashion is changing.”   Dr. Ross was part of consortium of PD researchers who published an online report August 31 in Lancet Neurology. The Genetic Epidemiology of Parkinson’s Disease (GEO-PD) consortium reported the identification of both risk and protective variants in the LRRK2 gene, perhaps the most notorious PD gene both for its dominant inheritance (50% of offspring inherit the gene) and for its association with Sergay Brin, the co-founder of Google who inherited LRRK2 from his mother.  Dr. Ross and colleagues found that, while some forms seem to carry increased risk of PD, others may protect against PD to some extent.

Obviously, as in many things, our view of the cause of PD is vastly different than it was just 10 years ago.  Hopefully, we will be eventually be able to get a handle on prevention of PD as well as a more satisfying treatment or even a cure.

I took a second look at this poem, written by a gentleman who has Parkinson’s disease. As Bonnie Silverman says, “It gives us all a little glimpse of why we are working so hard on Cause 4 Fashion.” Joe McEleavy is one of our Cause 4 Fashion “Models for the Cure.” Here it is for you to take in, as I have been reminded once more, why we do what we do:

I’m Still, By Joseph McEleavy

No matter how many little indignities,

dimishments and disappointments

My Life has thrown at me

I’m still Here

Sometimes giving up

Sometimes standing up

And though My Life seems to have become an ever failing effort to avoid embarrassment

I am still Joyous Optimism

Because no matter that my body freezes so that I cannot move

Shakes so that I cannot do

Or takes an hour to cook my 10 minute pizza

I’m still Here

No matter that the simplest tasks defeat me

That I seem to have lost my grace, wit and spontaneity

That I sometimes weep like a jilted bride

Forget relative importance easily,

Relearn painfully

No matter that I stumble like a drunk, act like a coward

Or that I sometimes just want to die, to be done

I’m still Here

Fighting to celebrate

My life