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PAPER |
1 National Hospital for Neurology and Neurosurgery, London, UK
2 Department of Neurology, Donauspital/SMZ-Ost, Vienna, Austria
3 Wessex Neurological Centre, University of Southampton, Southampton, UK
4 Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK
5 Medical Statistics Unit, London School of Hygiene and Tropical Medicine and Institute of Neurology, Queen Square, London, UK
6 Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
7 Phytrix Ltd, Munich, Germany
Correspondence to:
Correspondence to:
Professor A J Lees
Reta Lila Weston Institute of Neurological Studies, Windeyer Building, 46 Cleveland Street, London, W1T 4JF, UK; alees{at}ion.ucl.ac.uk
Background: The seed powder of the leguminous plant, Mucuna pruriens has long been used in traditional Ayurvedic Indian medicine for diseases including parkinsonism. We have assessed the clinical effects and levodopa (L-dopa) pharmacokinetics following two different doses of mucuna preparation and compared them with standard L-dopa/carbidopa (LD/CD).
Methods: Eight Parkinson’s disease patients with a short duration L-dopa response and on period dyskinesias completed a randomised, controlled, double blind crossover trial. Patients were challenged with single doses of 200/50 mg LD/CD, and 15 and 30 g of mucuna preparation in randomised order at weekly intervals. L-Dopa pharmacokinetics were determined, and Unified Parkinson’s Disease Rating Scale and tapping speed were obtained at baseline and repeatedly during the 4 h following drug ingestion. Dyskinesias were assessed using modified AIMS and Goetz scales.
Results: Compared with standard LD/CD, the 30 g mucuna preparation led to a considerably faster onset of effect (34.6 v 68.5 min; p = 0.021), reflected in shorter latencies to peak L-dopa plasma concentrations. Mean on time was 21.9% (37 min) longer with 30 g mucuna than with LD/CD (p = 0.021); peak L-dopa plasma concentrations were 110% higher and the area under the plasma concentration v time curve (area under curve) was 165.3% larger (p = 0.012). No significant differences in dyskinesias or tolerability occurred.
Conclusions: The rapid onset of action and longer on time without concomitant increase in dyskinesias on mucuna seed powder formulation suggest that this natural source of L-dopa might possess advantages over conventional L-dopa preparations in the long term management of PD. Assessment of long term efficacy and tolerability in a randomised, controlled study is warranted.
Abbreviations: AIMS, Abnormal Involuntary Movements Scale; AUC, area under curve; CD, carbidopa; COMT, catechol O-methyltransferase; LD, levodopa; 3-OMD, 3-O-methyl-dopa; UPDRS, Unified Parkinson’s Disease Rating Scale
Keywords: Mucuna pruriens; Parkinson’s disease; randomised controlled trial
This article has been cited by other articles:
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  O. Suchowersky, G. Gronseth, J. Perlmutter, S. Reich, T. Zesiewicz, and W. J. Weiner Practice Parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, April 11, 2006; 66(7): 976 - 982. [Abstract] [Full Text] [PDF]
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O. Suchowersky, G. Gronseth, J. Perlmutter, S. Reich, T. Zesiewicz, and W. J. Weiner Practice Parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, April 11, 2006; 66(7): 976 - 982. [Abstract] [Full Text] [PDF]
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