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

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 person with Parkinson’s disease. 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 and tapping speed to assess changes. They also recorded dyskinesia and adverse events. The MP group had a faster onset of effect (34.6 v 68.5 minutes; p = 0.021), which was also shown in blood studies of the pharmacodynamics. "On" time was longer in the MP group, 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, a paper by Cilia and colleagues describes another study of single-dose MP, but in their study the formulation was completely natural, not pharmacologically processed. The Cilia study used the powder taken directly from roasted MP seeds. Eighteen Parkinson’s disease patients were tested in 6 conditions, including a placebo condition. The Unified Parkinson’s Disease Rating Scale motor scores were recorded at 90 and 180 minutes. The authors  also measured the onset and duration of action. The UPDRS scores that showed motor improvement were similar in the MP and levodopa groups. Both preparations were better than the placebo condition. There were less dyskinesia and adverse events 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, but 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 people with Parkinson’s disease. Additionally, the management of Parkinson’s disease is complicated and dynamic. 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 expertise in 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.

“The Parkinson’s Pandemic: A Call to Action”
Wednesday, November 15, 2017

JAMA Neurology, “Viewpoint”, 11/13/17

Authors: E. Ray Dorsey, MD, Department of Neurology, University of Rochester Medical Center, Rochester, NY; and Bastiaan R. Bloem, MD, PhD, Radboud University Medical Center, Department of Neurology, Nijmegen, the Netherlands.

Novel Brain Scan May Reveal Mechanism of Cognitive Change in Parkinson’s
Thursday, August 17, 2017

A novel type of PET scan of the brain can detect changes associated with cognitive difficulties in Parkinson’s disease (PD), according to research published in the July 12 online edition of Neurology.  The finding suggests a new potential target for drugs to treat mild cognitive impairment in PD.

Brain MRI Tracks Parkinson’s Progression
Friday, August 18, 2017

Researchers at a Parkinson’s Foundation Center of Excellence have found that a brain MRI that uses a special protocol can track changes that occur as Parkinson’s disease (PD) progresses. This biomarker could be used in clinical trials, as an objective way to monitor whether the therapies being tested are effective. The study appears in the August 2017 issue of Brain.

FDA Approves Extended-Release Amantadine (Gocovri) for Treatment of Dyskinesia
Friday, August 25, 2017

The Parkinson’s Foundation alerts the community that extended-release amantadine capsules (GOCOVRI™) have been approved by the US Food and Drug Administration (FDA) for the treatment of dyskinesia in people with Parkinson's disease receiving levodopa-based therapy. This new approval was announced by the manufacturer on August 24.

Brain MRI Tracks Parkinson’s Progression
Friday, August 18, 2017

Researchers at a Parkinson’s Foundation Center of Excellence have found that a brain MRI that uses a special protocol can track changes that occur as Parkinson’s disease (PD) progresses. This biomarker could be used in clinical trials, as an objective way to monitor whether the therapies being tested are effective. The study appears in the August 2017 issue of Brain.

A Report on Pregnancy and Parkinson’s Disease
Friday, July 28, 2017

About half of women with Parkinson’s disease (PD) who become pregnant experience worsening of their PD movement symptoms during pregnancy, according to a new review of the sparse medical literature on PD and pregnancy.  For some, taking levodopa medications can help; and based on limited data, these drugs seem to be safe for both mother and child.

Activating Specific Brain Cells Points to New Strategies for Parkinson’s Therapy
Tuesday, July 25, 2017

In experiments with mice, scientists were able to activate certain brain cells to ease movement symptoms similar to those of Parkinson’s disease (PD). The results may help explain the effects of deep brain stimulation (DBS) A surgical treatment for Parkinson's disease.

Non-Surgical Deep Brain Stimulation Shows Promise in Animal Studies
Tuesday, July 11, 2017

In the June 1 edition of Cell, researchers describe a way to electrically stimulate areas deep within the brains of mice using electrodes placed on the scalp. If further research bears out these early results, the technique might eventually provide an alternative to deep brain stimulation, which uses surgically-implanted electrodes, as therapy for Parkinson’s disease (PD).

Extended-Release Amantadine May Help Dyskinesias
Monday, July 10, 2017

An extended-release formulation of amantadine is safe and effective for relieving troublesome dyskinesias in people with Parkinson’s disease (PD), according to a new study.  The results appear in the June 12 online edition of JAMA Neurology.  A decision on the drug’s approval by the US Food and Drug Administration (FDA) is expected this year, meaning it could be available to people with PD relatively soon.

New Evidence that the Immune System Can Be Activated in Parkinson’s
Wednesday, June 21, 2017

A new study funded in part by the Parkinson’s Foundation shows how the loss of brain neurons in Parkinson’s disease (PD) could, in part, result from an attack by a person’s own immune system.  Furthermore, the researchers link this attack to alpha-synuclein A protein in the human brain that is associated with the development of P

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