Parkinson's disease and movement disorders

Parkinson's disease is managed with dopaminergic medication — levodopa, dopamine agonists, MAO-B inhibitors — and the medication is the treatment. The adjuncts with evidence are behavioural, with one plant that is a specific hazard.

Exercise has the best evidence of anything in the adjunct category: aerobic and resistance training improve motor function, gait, balance and, in some trials, measures of disease progression. Physiotherapy and a structured programme are the intervention. This is free and it is underused.

Mucuna pruriens (velvet bean) contains levodopa — the same drug as the prescription. This makes it a dosing hazard: a person taking it alongside prescribed levodopa is taking an unmeasured dose of the same drug, with the risk of dyskinesia from excess or off-time from inconsistent content. It is not a herbal alternative to levodopa; it is unregulated levodopa. Anyone considering it needs to discuss it with their neurologist and have the dose accounted for.

Vitamin B6, B12 and folate. Levodopa is metabolised partly through methylation, and B6 metabolism is affected by levodopa therapy. B12 deficiency is common in Parkinson's disease and causes symptoms that mimic and worsen it. Get B12 checked.

Diet and medication timing. Levodopa competes with dietary amino acids for absorption and for transport across the blood-brain barrier, so a high-protein meal can reduce the effect of a dose. Protein redistribution to the evening is used by some people to reduce off-time. This is a neurology dietitian's decision.

CBD for epilepsy is a specific case, and it is mentioned here only to note that the evidence is for a specific pharmaceutical-grade preparation in specific epilepsy syndromes in children (Dravet, Lennox-Gastaut), with a specific effect on seizure frequency — and that it interacts with other antiepileptics. Artisanal CBD oil is not the studied product.

For multiple sclerosis, vitamin D adequacy, exercise and physiotherapy, disease-modifying therapy, and avoiding infection are the framework. Vitamin D is associated with risk and is worth correcting; it is not a treatment for MS.

Stroke prevention is largely the same as cardiovascular prevention: blood pressure, cholesterol, glucose, smoking, alcohol, exercise, weight, and treating atrial fibrillation. Atrial fibrillation is the specific cause that is frequently missed and is highly treatable — anticoagulation reduces stroke risk substantially.