THE EFFECT OF TAI CHI ON PARKINSON'S DISEASE

12th February 2012 - New research

New England Journal of Medicine [2012] 366 (6) : 511-519 (F.Li, P.Harmer, K.Fitzgerald, E.Eckstrom, R.Stock, J.Galver, G.Maddalozzo, S.S.Batya) People with Parkinson's Disease tend to have impaired balance, and an increased risk of falling. A clinical trial assessed the effect of Tai Chi on postural control in Parkinson's Disease. Tai Chi is a traditional Chinese martial art and form of exercise. For more information go to Tai Chi. Participants took part in 60-minute exercise sessions twice weekly for 24 weeks. Although the researchers claimed that Tai Chi performed consistently better than other methods, the improvement was only 5% better than resistance training, and 12% better than stretching exercises. The Tai Chi group performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai Chi lowered the incidence of falls when compared with stretching exercises but not when compared with resistance training.

Out of the previous studies in the medical literature concerning Tai Chi and Parkinson's Disease, four were either non-randomised or uncontrolled clinical trials. Two failed to show any effect. Only one study showed Tai Chi to be superior to conventional exercise for Parkinson's Disease. So the evidence is insufficient to suggest that Tai Chi is effective in Parkinson's Disease.

DUODENAL L-DOPA CAN CAUSE POLYNEUROPATHY

26th January 2012 - New research

Journal of Neurology [2012] Jan 24 [Epub ahead of print] (Santos-García D, de la Fuente-Fernández R, Valldeoriola F, Palasí A, Carrillo F, Grande M, Mir P, De Fabregues O, Casanova J.)  

Neurology [2011] 77 (22) : 1947-1950 (Y.A.Rajabally, J.Martey)

Reports have emerged describing the occurrence of polyneuropathy related to vitamin B12 deficiency and Guillain-Barré syndrome in people with Parkinson's Disease who are being treated with continuous duodenal L-dopa infusion. Duodenal L-dopa is administered as a gel throughout the day using a portable pump directly into the small intestine through a surgically placed tube. This ensures a flow of L-dopa that can be adjusted according to the patient's individual needs.

At least 12 cases of polyneuropathy related to vitamin B12 deficiency, and a case of Guillain-Barré syndrome have been reported in people with Parkinson's Disease treated with duodenal L-dopa infusion. L-dopa gel infusion may cause a decrease in vitamin B12 levels, leading to peripheral neuropathy. Other detrimental effects include alterations related to the metabolism of L-dopa, abnormal L-dopa absorption, and direct neurotoxicity of L-dopa at high doses. Vitamin B12 supplements may need to be considered in people with Parkinson's Disease on duodenal L-dopa infusion therapy, because vitamin B12 deficiency in people on duodenal L-dopa infusion therapy may be more frequent than the published data suggest.

In another new study, over a third (37%) of people with Parkinson's Disease were found to have neuropathy. Vitamin B12 deficiency was the most common cause. This could be made more likely by the long term use of L-dopa in any form. Many people with Parkinson's Disease who have neuropathy or Vitamin B12 deficiency are unaware of it.