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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 4  |  Page : 183-186

Management of Parkinson's disease through Ayurvedic approach: A case report


Department of Kayachikitsa, Rajiv Gandhi Government Post Graduate Ayurvedic College and Hospital, Paprola, Himachal Pradesh, India

Date of Submission29-Dec-2021
Date of Acceptance11-Nov-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Dr. Geetika Dharmani
Department of Kayachikitsa, Rajiv Gandhi Government Post Graduate Ayurvedic College and Hospital, Paprola, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_116_21

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  Abstract 


Parkinson's disease (PD) is a disease with insidious onset and slow progression. It is a neurologic condition that causes motor manifestations, namely, bradykinesia, rigidity, resting tremor, flexed posture, and nonmotor symptoms such as depression and dementia. PD can be correlated with Kampavata in Ayurveda based on similar symptomatology. The modern treatment provides some symptomatic relief but no proven means of slowing progression have yet been found. This present case is of a 72-year-old male patient who presented with complaints of tremors in both hands, and difficulty in speech and movement for 11 months which was increasing progressively and was hindering his routine activities. He was administered Kapikachhu and Ashwagandha for 60 days with follow-up after every 20 days. In every follow-up, the patient reported significant relief in his symptoms and after two months, he was able to perform his routine activities without any help. Kapikachhu and Ashwagandha are two easily available, noncontroversial Ayurvedic herbs, which can be used in the management of PD.

Keywords: Kampavata, Mucuna pruriens, Parkinson's disease, Withania somnifera


How to cite this article:
Dharmani G, Bhardwaj D. Management of Parkinson's disease through Ayurvedic approach: A case report. J Ayurveda Case Rep 2022;5:183-6

How to cite this URL:
Dharmani G, Bhardwaj D. Management of Parkinson's disease through Ayurvedic approach: A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2023 Jan 27];5:183-6. Available from: http://www.ayucare.org/text.asp?2022/5/4/183/365927




  Introduction Top


Parkinson's disease (PD) is a chronic progressive movement disorder, in which symptoms worsen over time as the result of malfunction and death of neurons. Causes of the disease are considered a combination of genetic susceptibility or exposure to one or more disease-triggering environmental factors.[1] PD mainly affects the neurons in the area of substantia nigra that produce dopamine, a chemical that transmits messages to the part of the brain that controls motor functions. As the disease progresses, the amount of dopamine production decreases leaving the person unable to control movements completely.[2]

The worldwide incidence of PD is estimated to be around 7–10 million with peak onset in the early 60s. Whereas, in India, the prevalence of PD is nearly 0.58 million persons as estimated in 2016, with an expected major increase in the coming years.[3] With better health facilities in today's era, the population of the geriatric age group is increasing so are the diseases. The neurological disorders that are observed in such a geriatric population are often degenerative in nature. Among them, “PD” is a common neurodegenerative disease after Alzheimer's disease.[4] James Parkinson gave the first description of PD in the early 19th century.[5] Based on similarities in symptomatology, PD can be correlated with Kampavata.[6] Under the name of “Vepathu,Kampavata was first mentioned as a separate clinical entity by Acharya Madhavakara with symptoms like Sarvanga kampa (~generalized tremors) and authors like Shri Govind Das Sen gave a description by explaining the clinical picture of Kampavata, i.e., Karapadatale kampa (~tremor in the hands and legs), Nidrabhanga (~sleep disturbance), Krshinamati (~slowness of utterance and thought). The clinical features are similar to PD. The symptoms such as Kampa (~tremor), Stamba (~rigidity), Chestasanga (~bradykinesia and akinesia), and Vakvikriti (~disturbance in speech) referred in Charaka and Sushruta Samhitas can also be considered as the possible symptom of PD under the context of Vatika disorders.[6],[7]

The most common diagnostic tool is the clinical acuity but magnetic resonance imaging is considered at times as it is a commonly prescribed investigation.[8] Catechol-O-methyltransferase inhibitors, Dopamine Antagonist (DA) agonists, and monoamine oxidase-B inhibitors are used in the treatment of PD but levodopa is the first drug of choice, as it provides a symptomatic benefit when the disease is relatively mild. As the disease progresses and treatment continues, complications related to treatment may develop, including short duration of response to individual doses of dopaminergic medication as the dosage of drugs acting on dopamine receptors or oral levodopa also increases.[9] Thus, there is a need for efficacious, rejuvenating therapy with minimal side effects.


  Patient Information Top


A 72-year-old male patient retired from the private sector (desk job), nonsmoker, nonalcoholic, presented with complaints of tremors in bilateral hands associated with difficulty in speech and movements for the past 11 months. Tremors developed gradually that were aggravating at rest and subsiding during movements. The tremors were increasing during stressful events. He mentioned that the tremors were so violent that even holding a glass became difficult. For the past 10 months, the patient noticed a tendency to fall forward while walking, slowness of movements, and speech, particularly difficulty in initiating the sentence.

Their appetite and thirst were normal but he complained of incomplete evacuation of stool last year. He also started to notice difficulty in initiating day-to-day activities such as slowness in eating food and holding objects, putting buttons, and difficulty in recollecting facts for 5 months. For this, he consulted a local physician and was prescribed medicines (details not available). He took this medication for about a month, but no significant relief was seen in his symptoms, so he abruptly stopped the medicine without consulting the local physician. Gradually, there was an increase in symptoms which compelled him to visit Ayurveda hospital.


  Clinical Findings Top


A male patient with a masking face and moderately built with 22 body mass index kg/m2 presented with complaints of uncoordinated movements and memory loss. His gait was festinating. On examination, his blood pressure was 134/88 mmHg and his pulse was regular and 78/min. The respiratory system, abdomen, cardiovascular system, recent and remote memory, deep tendon reflex, and superficial reflexes were within normal limits. On further examination, pill-rolling tremors, micrographia, and rigidity were present and glabellar tap was positive.

Ashtavidha pariksha (~Eight-fold Examination)

Nadi (~pulse) was Samanyagati (~normal rate) in character, Mala and Mutra (~both feces and urine) were Samanya (~normal), Jihwa (~tongue) was Aavrita (~coated), Sparsha (~tactile examination) was Ushna (~warm), Shabda (~voice) was Manda (~slow), Drik (~eyes and eyesight) was normal, and Akruti (~body stature) was Samanya (~normal).


  Diagnostic Assessment Top


Diagnosis of  Parkinsonism More Details is based on clinical presentation. As the patient had no other underlying comorbidity and fulfilled the cardinal features of parkinsonism,[10] the case has been diagnosed as PD. The four cardinal features of the disease, i.e., Tremor (~Kampa), Rigidity (~Stambha), Akinesia/bradykinesia (~Chestasanga), and Postural instability (~Asthirtha) were presented in the case. For the evaluation of the effect of treatment grading of subjective parameters has been adopted as mentioned in [Table 1].
Table 1: Grading of assessment criteria*

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  Timeline and therapeutic interventions Top


The treatment given in the present study was Kapikachhu [Mucuna pruriens (L.) DC] powder (5 g) with 100 ml water twice daily and Ashwagandha [Withania somnifera (L.) Dunal] powder (5 g) with milk twice daily after meals. The duration of therapy was 60 days with follow-up after every 20 days.


  Follow-up and outcome Top


A marked reduction in the symptoms after treatment was seen. The tremor reduced from grade four to grade one after the treatment in bilateral upper limbs and grade three to grade one in bilateral lower limbs [Table 2]. There was a significant improvement in rigidity from grade three to grade zero. Bradykinesia also reduced from grade four to grade zero, whereas postural instability also reduced from grade four to grade one [Table 2]. An overall description of grades before and after treatment is formulated in the figure below [Figure 1].
Table 2: Effect of treatment on tremors, rigidity, akinesia/bradykinesia, and postural instability

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Figure 1: Bar diagram represents outcomes before and after trial

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  Discussion Top


The objective of Ayurveda is to protect the health of the body and to alleviate symptoms and manage diseases. As age commences, Vata dosha increases exponentially. Therefore, the risk of Vatavyadhi in the geriatric age group is more. The main etiological factors leading to Vatavyadhi are Dhatukshaya (~tissue degeneration and damage) and Margavarana (~neuro obstructive diathesis). PD coincides with Kaphavritavyana and Udanavayu in many stages of the disease. Bala (~physical endurance) is the contribution of Udanavata, whereas Gati (~gait) is the property of Vyanavayu. The functions of both Udanavata and Vyanavata seem to be deranged in PD. As for the status of Doshas in PD, Vata is Vridha (~increased) or Kupita (~vitiated), Pitta is Ksheena (~decreased), and Kapha is Vridha and Kupita. There is Rasakshaya (~depletion) at the level of Dhatus. Here, the Avritadosha is Kapha and the Avaraka is the Udana and Vyanavayu.[11] Features of Kaphavritavyana are Cheshtahani (~bradykinesia), Kampah (~tremors), and Gatisanga (~akinesia), whereas postural instability is also the manifestation of Kaphavritaudana.[12] Vigraha (~dysarthria) is manifested in both Kaphavritavyana and Udana. As one of the major factors responsible for PD is Dhatukshaya so, the use of Rasayana (~rejuvenation therapy) can substantially lower the risk of Vatavyadhi.

Ashwagandha is a potent Rasayana and it has several pharmacological actions such as neuroprotective,[13] antiarthritic,[14] analgesic,[15] and anti-inflammatory.[14] Considering its neuroprotective activity, Ashwagandha powder is used in this study.

In PD, striatal dopamine levels can be increased either with precursor substitution and/or by reducing its breakdown and is the mainstay of treatment but there is a steady increase in the dose of levodopa as the disease progresses.[16] At higher doses, it causes motor complications.[17] Hence, drugs such as Kapikachhu, which is a natural source of dopamine will be helpful. The seeds of Kapikachhu are said to be a good natural source of 3,4-dihydroxyphenylalanine (L-Dopa).[18] The seed extract shows a potent antiparkinsonian effect as it enhances the level of catecholamine, improves motor activity, reduces free radical generation, and attenuates the activation of astrocytes.[19] Thus, significant relief in symptoms is seen in this case. A possible synergistic effect of both drugs may be responsible for improving the neurochemical levels, antioxidant status, and behavior patterns significantly.[20],[21] No untoward effects were noticed during the treatment period.


  Conclusion Top


Degenerative disorders are a big challenge to our society. With the increase in the geriatric population, newer modalities are to be developed to prevent and treat such diseases. The versatile mode of action of the drugs helps the patient at a comparatively lesser cost. In the present study, the degenerative disease deteriorated the lifestyle of the patient as it affected the routine, gait, and thought process including speech. Kapikachhu and Ashwagandha used in this case seems to be acting synergistically and helped in controlling the pathology without developing any adversities.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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