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What's Hot in PD? Update on the Use of Mucuna Pruriens for the Treatment of Parkinson’s Disease

What's Hot in PD? - August 2017

Mucuna pruriens variant utilis (MP) has long been used as an alternative to over the counter levodopa. MP is a leguminous plant that grows in both tropical and subtropical environments. Hidden in its seed is levodopa, which is the most important medication for a Parkinson’s disease patient. In this month’s What’s Hot we will review the studies supporting MP use and discuss future directions and global implications for this therapy.

In 2004, Katzenschlager performed a double blind study of MP.  Though the study was small and included only eight Parkinson's disease subjects it was a well done randomized double blind crossover trial. The subjects were administered single doses of 50/200 mg Sinemet, and 15 and 30 grams of MP at several weekly intervals. The authors used the Unified Parkinson's Disease Rating Scale as well as measuring tapping speed. They also recorded dyskinesia and adverse events. The MP had a faster onset of effect (34.6 v 68.5 minutes; p = 0.021) and this was also shown in blood studies of the pharmacodynamics. On time was longer and there were no differences in adverse effects or in the development of dyskinesia. The Katzenschlager study used a processed pill form of MP (Katzenschlager, 2004).

This week Cilia and colleagues also studied a single-dose of MP, but in their study the formulation was non-pharmacologically processed (completely natural). The Cilia study used the powder directly taken from roasted seeds. Eighteen Parkinson’s disease patients were tested in 6 conditions including a placebo condition.  The Unified Parkinson’s disease motor scores at 90 and 180 minutes were recorded and also the authors measured the onset and duration of action. The UPDRS scores which showed motor improvement were similar in the MP and levodopa groups.  Both preparations were better than the placebo condition. There was less dyskinesia and AE’s in the MP groups. The higher dose MP had a better on response and a longer duration of action (Cilia, 2017).

These studies support the idea that MP is a safe alternative to over the counter levodopa. There may be some benefits including a faster onset, longer life, and fewer adverse events, however the results of these studies should be interpreted with caution. There were very few patients in both studies and the findings may not be representative of the wide spectrum of Parkinson’s disease patients. Additionally, the management of Parkinson’s disease is complicated and dynamic. The frequent changes and adjustments to medication usually underpin successful management. Using an over the counter pill form or a natural powder form could prove challenging to adjust and to manage even for the most experienced practitioner. If you are interested in MP, we recommend that it be managed by a neurologist with some expertise or experience with Parkinson’s disease. A larger and longer duration study could unlock the secrets to MP use and could make levodopa available in regions of the world without proper access to Parkinson’s medications.

Selected References

Katzenschlager R, Evans A, Manson A, et al. Mucuna pruriens in Parkinson’s disease: a double blind clinical and pharmacological study. J Neurol Neurosurg Psychiatry 2004;75:1672-77.

Cilia R, Laguna J, Cassani E, Cereda E, Pozzi NG, Isaias IU, Contin M,
Barichella M, Pezzoli G. Mucuna pruriens in Parkinson disease: A double-blind,randomized, controlled, crossover study. Neurology. 2017 Jul 5. pii:10.1212/WNL.0000000000004175. doi: 10.1212/WNL.0000000000004175. [Epub ahead of print] PubMed PMID: 28679598.

Okun MS. Use of Mucuna Pruriens Powder Instead of Levodopa. NEJM Journal Watch Neurology, August 2017.

You can find out more about PF's National Medical Director, Dr. Michael S. Okun, by also visiting the Center of Excellence, University of Florida Health Center for Movement Disorders and Neurorestoration. Dr. Okun is also the author of the Amazon #1 Parkinson's Best Seller 10 Secrets to a Happier Life and 10 Breakthrough Therapies for Parkinson's Disease. You can read more from Dr. Okun in the What's Hot in PD? archives.