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Alternative Therapies include herbal and nutritional supplements, exercise and massage techniques. A strong evidence for their benefit is lacking in general. Patients with Parkinson Disease (PD) routinely come across them and as many as 40% end up trying one of them. Here we will very briefly summarize the available scientific support for them, if any.

Acupuncture, is an ancient Chinese technique based on idea of stimulating energy centers in body through needles. Although several small clinical trials reported modest benefit, a meta-analysis of all combined found them no better than placebo. Some functional studies of brain have shown effects on brain; but if it translates to a clinical improvement, is not clear. The current evidence favors a placebo response.

Exercise techniques from old cultures like Tai ChiQigong (predecessor of tai chi and is more meditative) and Yogahave all shown some benefits in small studies. Tai Chi, the best studied, showed significant improvement in motor performance with fewer falls, compared to regular exercise.

Similarly different massage techniques (including reflexology, Trager therapy) in small studies showed improvement in Quality of Life and patient report of function. Another technique using Vibration for therapy may also be helpful, at least as a placebo. Music therapy including dancing and stepping on rhythmic cues have shown to be helpful with walking and balance.

Use of Herbal supplements is more complicated. Most commonly used supplements of Velvet beans (mucuna puriens), and Broad beans (Vicia faba) are known to health care providers since ancient times. These beans mainly have Levo-DOPA (the most common and effective medical treatment for Parkinson disease) and it was originally extracted from its herbal source. These herbal extracts have shown to be similar in activity to pharmaceutical preparation. Any added advantage is not fully clear. One small study did show mucuna preparation being quicker in onset and longer lasting. However, there are no reliable suppliers of mucuna, and some suppliers tested had no mucuna/levodopa in the capsule. Some other compounds may be present in herbal extracts but their role is not clear; however similarities to other known pharmaceutical drugs in their mechanism of action have been noted.

Many other herbal and nutritional supplements have either never been studied in PD (such as Ginkgo biloba), or have outright failed to show benefit in Large well designed clinical studies (such as Co-Q10 and Vitamin E).

Role of Cannabis is even more complicated to understand. It is clear that Smoking cannabis has same cancer risks as smoking tobacco and oral formulation would be preferable, if found to be helpful. Cannabis receptors are present in the part of brain affected by PD. However their role may be mixed in reducing tremors but worsening slowness or vice versa. Added to this is the fact that there are over 60 psychoactive compounds in cannabis including both, ones that activate and others that inhibit the receptor. Further complicating the matter is that the type and quantity of chemicals differ between strains of Cannabis plant. There are small clinical studies suggesting improvement in motor features and larger trials with purified chemical extract from cannabis are underway.

To summarize, some alternative therapies have no significant added risk. Thus even though they may have only placebo benefits are worth trying. Others (like Tai Chi) are clearly beneficial. While many herbal/nutritional products are either clearly not beneficial (Co-Q10, Vitamin E) or potentially harmful in their current state of use (Mucuna, Cannabis).

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