A Randomized Controlled Trial of Chinese Medicine on Nonmotor Symptoms in Parkinson’s Disease

Abstract

Nonmotor symptoms (NMS) of Parkinson's disease (PD) have devastating impacts on both patients and their caregivers. Jiawei-Liujunzi Tang (JLT) has been used to treat some NMS of PD based on the Chinese medicine theory since Qing dynasty. Here we report a double-blind, randomized, placebo-controlled, add-on clinical trial aiming at evaluating the efficacy and safety of the JLT in treating NMS in PD patients. We randomly assigned 111 patients with idiopathic PD to receive either JLT or placebo for 32 weeks. Outcome measures were baseline to week 32 changes in Movement Disorder Society-Sponsored Revision of Unified PD Rating Scale (MDS-UPDRS) Parts I–IV and in NMS assessment scale for PD (NMSS). We observed improvements in the NMSS total score (p = 0.019), mood/cognition (p = 0.005), and reduction in hallucinations (p = 0.024). In addition, post hoc analysis showed a significant reduction in constipation (p < 0.001). However, there was no evidence of improvement in MDS-UPDRS Part I total score (p = 0.216) at week 32. Adverse events (AEs) were mild and comparable between the two groups. In conclusion, long-term administration of JLT is well tolerated and shows significant benefits in improving NMS including mood, cognition, and constipation.

Comprehensive Examination of Therapies for Pain in Parkinson’s Disease: A Systematic Review and Meta-Analysis

“…One study pooled the results of 2 (RCTs [16]. Thus, 25 RCTs were included with a total of 1,744 patients undergoing a therapeutic intervention and 1,610 patients undergoing a control intervention. Agreement between the reviewers for study eligibility was moderately high (κ = 0.724, 95% CI [0.479-0.969], p < 0.0001) and the agreement for risk of bias assessment was very high (intraclass correlation coefficient = 0.856, 95% CI [0.714-0.927], p < 0.0001).…”

“…The number of trials for each identifiable therapeutic intervention category was 3 for dopaminergic agonists [17][18][19], 2 for cannabinoids and opioids [20,21], 3 for surgical methods [22][23][24], 4 for electrical or Chinese therapies [25][26][27][28], 2 for pardoprunox [29,30], 2 for safinamide [16], 1 for catechol-O-methyltransferase (COMT) inhibitors [31], 1 for multidisciplinary team care [32], and 7 for miscellaneous therapies. Miscellaneous therapies included hydrotherapy [33,34], massage therapy [35], gym training [36], mindfulness therapy [37], vibration therapy [38], and power yoga [39] (Table 1, with further intervention details in Appendix 4).…”

“…Pain severity was reported in 8 trials using the pain subscale of the Visual Analogue Scale (VAS-P) [17,24,26,27,29,30,33,35], in 8 using section 39 of the Parkinson's Disease Questionnaire-39 [16,22,23,31,32,36,37,39], in 4 using the Likert pain scale [18,19,34,38], in 1 using the King Parkinson's Disease Pain Scale [21], in 1 using question 1.9 of the Movement Disorders Society -Unified Parkinson's Disease Rating Scale (MDS-UPDRS Q1.9) [25], in 1 using the McGill Pain Scale [20], and in 1 trial using the Daily Pain Rating Sheet [28] (Table 1).…”

“…Ten studies qualified for the secondary sensitivity analysis, of which 2 were dopaminergic agonists [17,19], 1 was part of the cannabinoids and opioids class [21], 3 among the electrical and Chinese therapies [25,27,38], and 1 each for miscellaneous therapies [37], pardoprunox [30], safinamide [16], and COMT inhibitors [31]. Cannabinoids and opioids experienced a -0.02-unit reduction in pain severity (SMD = -2.26 vs. SMD = -2.24), electrical and Chinese therapies displayed a -0.13-unit reduction in pain severity (SMD = -1.11 vs. SMD = -0.98), and a -0.12-unit reduction in pain severity was seen for pardoprunox (SMD = -0.62 vs. SMD = -0.50).…”

Factors Affecting Telemedicine Acceptance in Patients with Parkinson's Disease

“…Parkinson's is a chronic disease and a type of neuromuscular disorder that occurs due to the analysis of dopamine-producing brain cells (a type of neurotransmitter) often in old age and over 60 years. Due to its high social impact and high incidence of the disease, it has been chosen as the second neurological disorder after Alzheimer's disease [1]. Approximately 66% of patients develop disability within the first 5 years and 80% after 10 years.…”