Parkinson's disease with acupuncture treatment.

1 in 500 people are affected by Parkinson’s disease (PD), a condition caused by loss of nerve cells in the part of the brain. It is the second most common neurodegenerative disease after Alzheimer’s disease. These cells produce a chemical called dopamine. Because of the loss, dopamine production was reduced leading to three main symptoms of the condition, tremor, muscle stiffness and physical slow movement. Numerous nonmotor symptoms including neuropsychiatric disturbance, abnormal sensation, sleep disorders, and autonomic dysfunction are also present. Complementary and alternative medicine (CAM) plays an important part in the treatment of the condition.

Lokk J and Nilsson M studied use of CAM in patients with Parkinson’s disease at a neurological outpatient clinic Sweden. They studied the frequency, type and factors associated with the use of CAM in all patients with PD 421 in the outpatient clinic. The patients received questionnaire. 172 men and 153 women responded the questionnaire. 30% and 39% women used CAM and acupuncture usage was in the highest frequency.

Acupuncture, is used to treat PD in China. Although the therapeutic effect of acupuncture in PD is under debate, increasing evidence shows that it can alleviate motor symptoms and nonmotor symptoms, such as sleep and pain and mood disturbances and improve the quality of life in PD patients.

The effectiveness of acupuncture in treating PD was observed in research. Recently researchers used the magnetic resonance imaging (MRI) to investigate the effect of acupuncture stimulation in brain activity. They found that acupuncture stimulation in aupoint GB34 increased neural responses in regions including substantia nigra, caudate, thalamus and putamen which are the impaired regions caused by PD.

There was a study on effectiveness of acupuncture on twenty patients with PD with mean age 68 years disease duration 8.5 years. On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. Acupuncture therapy is safe and well tolerated in PD patients.

Recently Zeng et al have shown that acupuncture stimulation in Parkinson'smodels had generated valuable mechanistic insight of Parkinson's and showed that acupuncture treatment is a neuroprotective therapy that increase the release of various neuroprotective agents such as brain-derived neurotrophic factor, glial cell line-derived neurotrophic factor, and cyclophilin A. In addition, acupuncture therapy slows cell death process and attenuates oxidative stress to dopaminergic neurons in the substantia nigra. Further, acupuncture therapy modulates neuronal activity of the basal ganglia output structures. These results suggest that early application of acupuncture therapy to Parkinson's patients may be helpful for the best efficacy of acupuncture treatment. It is hopeful that translation of achievement in acupuncture research in Parkinson's models will maximize the potentials of acupuncture treatment.

Recently more studies were published showing that acupuncture activates brain in patients with Parkinson’s disease and patients with mild cognitive impairment. For example, magnetic resonance imaging (MRI) is a new technique that helps researcher and clinicians understand brain function. Using this technique, we can see how acupuncture stimulates the brain and alters brain function. There was a study in which brain activation in response to acupuncture in a group of 12 patients with Parkinson’s disease was compared with a group of 12 healthy participants. Acupuncture was conducted on a specific acupoint, the right GB 34 (Yanglingquan), which is a frequently used acupoint for motor function treatment. The result has shown that Acupuncture stimulation on this acupoint activates the prefrontal cortex, precentral gyrus, and putamen in patients with PD; areas that are known to be impaired in patients with PD. Compared with healthy participants, patients with PD showed significantly higher brain activity in the prefrontal cortex and precentral gyrus, especially visible in the left hemisphere.

Another study investigated whether acupuncture at Taixi (KI3) acupoint in elderly patients with mild cognitive impairment can activate neurons in some brain regions. Results showed that 20 brain regions were activated in participants, including the bilateral anterior cingulate gyrus (Brodmann areas [BA] 32, 24), left medial frontal cortex (BA 9, 10, 11), left cuneus (BA 19), left middle frontal gyrus (BA 11), left lingual gyrus (BA 18), right medial frontal gyrus (BA 11), bilateral inferior frontal gyrus (BA 47), left superior frontal gyrus (BA11), right cuneus (BA 19, 18), right superior temporal gyrus (BA 38), left subcallosal gyrus (BA 47), bilateral precuneus (BA 19), right medial frontal gyrus (BA 10), right superior frontal (BA 11), left cingulate gyrus (BA 32), left precentral gyrus (BA 6), and right fusiform gyrus (BA 19).

More recently acupuncture as an additional treatment with drugs was studied. In this study, patients with PD were allocated into two groups, acupuncture plus drug group and drug only group. The result has shown that tremor, rigidity, and bradykinesia, are all significantly decreased in acupuncture group. Sleep quality and depression were also significantly improved in acupuncture group.

A group of experiments from animal models of PD indicate that acupuncture is effective in reducing oxidative stress , decreasing neuroinflammation with a major feature of microglial activation, stimulating release of neurotrophic factors, and regulating homeostasis of the network between cortex and striatum.

Acupuncture reduces oxidative stress of the cells

Oxidative stress is a sign of the imbalance between the production of reactive oxygen species and detoxification of the antioxidant system. As a result, this causes cell function damage and diseases. Oxidative stress is a critical feature in the pathological process of various diseases such as vascular dementia, Alzheimer’s disease and Parkinson’s disease. Recent research from last 5 years has shown that acupuncture treatment could decrease oxidative stress of the body and increase antioxidant system ability. Because of this acupuncture could improve memory impairment in vascular dementia and Alzerimer’s disease and reduce brain damage. Increased oxidative stress and depletion of the antioxidant are important mechanisms of the onset and progression of Parkinson’s disease. Acupuncture could reduce oxidative stress, inhibit cell death in the neurons and protect neurons improving motor function.

Recently a study assessed the effect of acupuncture for PD. In this study 19 randomized controlled trials were included and it found that acupuncture was effective in relieving PD symptoms compared with no treatment and conventional treatment alone, and acupuncture plus conventional treatment had a more significant effect than conventional treatment alone. Acupuncture does have positive effect for patients with PD.

Loddk J and Nilsson M Parkinsonism Relat Disord (2010) 16:540-4
Yeo S et al CHS Neurosci Ther (2012) 18:781-90
Shulman LM et al Mov Discord (2002) 17:799-802
Zeng et al (2013) Int Rev Neurobiol (2013) 111:141-58
Yeo Et al BMC Complement Altern Med (2014) 14:336
Chen et al Neural Regen Res (2014) 9:1163-8
Wang F et al Evid Based Complement Alternat Med (2015) 2015:692795
Zeng XH et al Evid Based Complement Alternat Med (2014) 2014:483294
Lee SH et al Medicine (Baltimore) (2017) Jan;96(3):e5836. doi: 10.1097/MD.0000000000005836.

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