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Find out which jobs in New Zealand pay the most and the least, and how your qualifications can affect your earnings.

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Rose Renton sparked a nationwide debate after she fought for her 19-year-old son, Alex, to become the first person to get approval to use medicinal cannabis.

Alex died of severe epilepsy in 2015, but today Mrs Renton took her battle to Parliament, imploring MPs to legalise medicinal cannabis.

Mrs Renton and medical marijuana supporters appeared before the health select committee, to speak to her 17,000-signature petition calling for easier, cheaper access.

She said medicinal cannabis was only granted to her son after a long battle with medical staff for backing, and after 43 other drugs had failed.

Those suffering from chronic or terminal illness deserved urgent access to good-quality, safe, affordable cannabis, she said.

Mrs Renton told the committee she was contacted every day by people who were desperate, dying and terrified because of the current laws.

She said it was time for MPs to show some empathy and stand up for the people they represented.

"These people are all adults, they are not young people. They are people that have educated themselves.

"You are here to look after your people and I'm asking you to take the pressure off me as a mum with six kids. My children would like me back," Mrs Renton said.

When a sick person used cannabis they did not get high, she said.

"When a well person uses cannabis they get high - their system doesn't need it. That's a recreational issue, it's not a medical issue.

"When you've got a very sick person, the side effects of cannabis - an appetite, a great night's sleep and a bit of hilarity - they're the side effects of cannabis as a medicine for sick people."

'There is evidence that it's relatively safe'

This year the government said ministerial sign-off for the use of medicinal cannabis-based products was no longer required.

Instead, approval was delegated to the Health Ministry.

There is one product registered for use here - it is imported and costs $1200 for one month's supply.

Ministry of Health director of regulation Stewart Jessamine said there was a lack of meaningful research on cannabis products and whether they caused harm.

He said all things were poisonous - it was just a matter of dosage.

The Green Party member on the committee, Julie-Ann Genter, questioned Dr Jessamine on how cannabis compared with the use of legal products.

"Irrespective of the lack of clinic trials establishing whether or not it's effective at pain relief, there is evidence that it's relatively safe compared to other things that are legal like alcohol," Ms Genter asked.

Dr Jessamine replied it was because there were other more effective pain relievers available that could be prescribed by a doctor.

Ms Genter asked how they were less harmful.

"It seems a little odd that this is being treated with such caution," she said.

Dr Jessamine said the ministry treated all new drugs with the same caution.

Sue Grey, a lawyer who appeared alongside Rose Renton, told MPs the health system was spending $130 million a year on opioid drugs that cannabis could potentially replace.

Some caused serious side effects "yet they're part of the system so we're just accepting that let's just carry on using them", Ms Grey said.

"Why not look for better, safer alternatives that the rest of the world are turning to?"

Mrs Renton said chronically ill people should have the right to choose what drugs they took, with the support of their doctor.

She said their health was in MPs' hands.

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Mother calls for MPs' empathy on medicinal cannabis

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Rose Renton sparked a nationwide debate after she fought for her 19-year-old son, Alex, to become the first person to get approval to use medicinal cannabis. Alex died of severe epilepsy in 2015, but today Mrs Renton took her battle to Parliament, imploring MPs to legalise medicinal cannabis.

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Seriously ill patients seeking medicinal cannabis to ease their symptoms will no longer have to take their cause right the way to the top, but access to the drugs will remain tightly controlled.

From today, authority to approve applications for non-pharmaceutical grade medicinal cannabis products no longer resides with the Minister.

Instead the Ministry of Health has ultimate sign-off for all applications, Associate Health Minister Peter Dunne announced.
READ MORE:
* Obituary: Union leader Helen Kelly
* Helen Kelly on cancer, dying and bad access to good medicine
* Peter Dunne approves cannabis product for Tourette's patient
* Woman wins legal victory for medicinal cannabis
"Last week I wrote to the Director-General of Health, advising him that as of February 8, 2017, applications from specialists to the Ministry to prescribe non-pharmaceutical cannabis-based products will no longer need ministerial approval," Dunne said in a statement.

The Ministry of Health already had the power to sign-off on a specialist's application to prescribe pharmaceutical-grade drug Sativex, and in December last year, that need for approval was removed for clinicians wanting to prescribe the drug to people suffering multiple sclerosis.

Dunne has hinted more changes could be on the way, to further loosen prescribing rules for specialists wanting to prescribe Sativex for conditions other than multiple sclerosis.

It may have been this, that Health Minister Jonathan Coleman was referring to in comments he made on Tuesday, suggesting more prescribing authority could be placed with specialists.

Dunne said Wednesday's changes recognised that application procedures had been tested to a level where he could feel confident he wasn't throwing officials under the bus, by delegating them approval authority.

"As I stated in my delegation letter to the director-general, when applications first began to be received it was my view that the final decision appropriately lay at ministerial level, rather than exposing officials to risk, given the complicated and contentious nature of the issue - that is to say the buck stopped with me".

The Green Party has welcomed the change as a "step in the right direction", but said it did not go far enough.

"Peter Dunne has removed one hoop New Zealanders have had to jump through to get access to medical cannabis, but there are still many more that need to go before people can get the medicine they need," said party health spokesperson Julie Anne Genter.

"With the advice and support of their doctor, New Zealanders should be able to access medical cannabis as easily and as cheaply as they do any other prescription drug - the announcement today doesn't allow that to happen."

Professor Paul Smith, professor of neuropharmacology at Otago University said it was a positive step forward, while taking a cautious approach in an emerging area of medicine.

"The evidence that they work for some conditions like neuropathic pain is not entirely consistent or convincing, but they do appear to help some people. So, it is a question of benefit versus burden for a particular condition.

"In the case of terminal illness, there is not much reason to have concerns because the harm will be minimal and the patient may benefit," he said.

Dunne has been carrying out a review of the regulations around medicinal cannabis for more than a year, and the announcement follows a string of high-profile cases in which terminal patients have died fighting for the drugs to ease pain or seizures.

Most recently, Trade Unionist Helen Kelly died in October last year, after a lengthy battle with lung cancer. In the months before her death, she detailed how tumours had broken her back, but medicinal cannabis was the only thing keeping the pain away.

Kelly applied for a medicinal cannabis product outside the approved New Zealand schedule but the application was later withdrawn from the Ministry of Health. Both Dunne and Health Minister Jonathan Coleman had expressed comments at the time, that Sativex would have been appropriate.

Kelly said it left her with little choice but to take her own products illegally.

Nelson teen Alex Renton died in July 2015 after being hospitalised in "status epilepticus", a kind of prolonged seizure. It was not known what caused the seizures.

Dunne approved a petition to the Government from Alex's family to allow him to be treated with a medicinal cannabidiol oil, Elixinol. Renton's seizure stopped and he regained consciousness shortly before his death.

But it emerged afterwards that Renton's mother had administered the drug to her son before approval was given.
* Comments on this story are now closed.
- Stuff

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Victory for medicinal cannabis campaigners as laws are loosened

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Seriously ill patients seeking medicinal cannabis to ease their symptoms will no longer have to take their cause right the way to the top, but access to the drugs will remain tightly controlled. From today, authority to approve applications for non-pharmaceutical grade medicinal cannabis products no longer resides with the Minister.

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Richard Charteris experienced the best high of his life when the electrodes implanted in his brain were switched on and his debilitating Parkinson's symptoms immediately vanished.

"It was wonderful, very emotional," the 60-year-old New Plymouth man says after 10 years struggling with the incurable, progressive neurological condition.

In August, Mr Charteris became the first in Taranaki to be approved for deep brain stimulation (DBS) surgery at Auckland Hospital.

It reduces, but does not eliminate symptoms of Parkinson's disease.

Unusually, Mr Charteris is experiencing what he describes as a 100 per cent improvement and is now mostly medication-free. Most people experience a partial improvement and still need to take their drugs.

After the operation, a friend came back from Australia to visit him and was so impressed at the improvement he saw in his mate he said he must have felt like he'd won Lotto.

"I said, 'It's better than Lotto. Lotto wouldn't have made a scrap of difference compared to what this has done for me.'

"I was on a high there for a few days.

"They were a bit worried about me for a while. It was the best drugs I've ever had," he says with a broad smile.

Mr Charteris was assessed as eligible for DBS because his medication, which had worked very effectively in the early years, started to cause serious side effects.

He was suffering overwhelming tiredness.

The two-day eligibility assessment was a huge ordeal to go through, not knowing whether he would get approval, he recalls.

He was assessed by a neuro-psychologist and neuro-psychiatrist as to his suitability and withdrawn from medication.

He was closely observed as the medication was given to him again.

If it worked to control symptoms, he would be crossed off the list.

Then there were the risks of the operation itself, including the possibility of a stroke and infection.

"But I was positive it was going ahead. Others who had the operation that I spoke to told me, 'don't muck around, go for it'.

"I was pretty much borderline because of the adverse effect [of the medication] but it was the points on the other side that pretty much carried the day."

As such, he became one of 14 New Zealanders who are approved each year for DBS through the public health system.

The $80,000 operation involves implanting electrodes into the patient's brain. These are connected to an implanted neurostimulator in his chest which creates electrical currents which help control motor symptoms of Parkinson's.

He has a hand-held neurotransmitter which can turn off the power if need be.

Mr Charteris describes how the only painful part of the procedure was the local anaesthetic.

He was awake all through the long hours of brain surgery so the neuro-surgical team, which is headed by neurologists Barry Snow and Mark Simpson, could ensure he was receiving the correct voltage.

As he sat in a semi-prone position he was asked to recite the days of the week as they tweaked the speed of his speech up and down until they were satisfied he was talking normally and they had the right levels.

There was no pain as surgeons drilled the holes. "It was like taking a jackhammer to your skull. It was like a torture chamber. I was just about laughing.

"But by 6 1/2 hours I'd pretty much had enough."

Six weeks later, he returned to have the second stage under general anaesthetic when the pacemaker was implanted in his chest.

About every five years the batteries in the pacemaker will need to be replaced.

In thanking the specialist nurse, Lorraine McDonald, he told her the care he received in Auckland hospital was top of the line.

"I said that if she was a car dealer I'd be going back to her because the after-sales service was second to none. "

Mr Charteris shared his experience with the Parkinson's NZ North Taranaki branch on Tuesday and with the Taranaki Daily News.

Unfortunately, the operation is not available to all Parkinson's sufferers, field officer Sue Allemann says.

"It is only available to under 70-year-olds and it's only for people whose medication isn't working well for them."

The benefits of DBS for Parkinson's decline with advancing age, and the risks, especially of a stroke and infection increase.

Seventy is the cut-off age because of the challenging nature of the operation and the benefits for older people - whether it's worthwhile putting them through the stress of the operation, she says.

In New Zealand the procedure has been available since 2009 and only through the neurosurgical team based at Auckland Hospital. Before then, the few who successfully went through the rigorous assessment process were sent to Brisbane.

By the middle of last year, the statistics show that of the 56 New Zealanders who have applied, 23 received the operation.

Some of the world's most high-profile Parkinson's sufferers, New Zealand's John Walker and United States boxer Mohammed Ali and movie man Michael J. Fox have not had the operation.

Mrs Allemann said Mr Charteris is her first client to have the operation and hopefully more will follow.

"I was really delighted. It's been such a positive outcome."

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Richard Charteris experienced the best high of his life when the electrodes implanted in his brain were switched on and his debilitating Parkinson's symptoms immediately vanished. "It was wonderful, very emotional," the 60-year-old New Plymouth man says after 10 years struggling with the incurable, progressive neurological condition.

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deep brain stimulation for parkinson disease overview

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Deep Brain Stimulation for Parkinson Disease: Overview, Mechanism of Action, Advantages and Disadvantages

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Deep brain stimulation (DBS) was first used in the 1970s for the treatment of chronic pain. Mixed results and poor electrode design caused a cessation of significant activity in this field in the 1980s, but over the ensuing 20 years, DBS reemerged as one of the most effective treatments for advanced movement disorders.

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SCIENTISTS are on the brink of finding a cure for Parkinson's disease after discovering what causes the illness and how it affects brain cells.

Experts previously thought people who fell ill at a younger age than most who develop Parkinson's suffer from a poorly functioning 'mitochondria'.

These are the powerhouses of cells and without reliable sources of energy, neurons wither and die.

But Medical Research Council researchers at University of Leicester found this may not be the complete picture of what is happening within the brain cells affected by Parkinson's.

Now it is thought neuro deterioration occurs in response to stress on the endoplasmic reticulum (ER) - part of the outer skin of the cell - rather than failure of the mitochondria as previously thought.

During the study fruit flies were injected with chemicals to prevent the effects of ER stress and as a result, it prevented the death of neurons which are commonly associated with the disease.

Dr Miguel Martins said: "This research challenges the current held belief that Parkinson's disease is a result of malfunctioning mitochondria.

"By identifying and preventing ER stress in a model of the disease it was possible for us to prevent neurodegeneration.

"Lab experiments, like this, allow us to see what effect ER stress has on Parkinson's disease.

"While the finding so far only applies to fruit flies, we believe further research could find that a similar intervention in people might help treat certain forms of Parkinson's."

Leicester's MRC Toxicology unit in Leicester carried out the experiment.

They used "mutant" fruit flies to test the chemicals as the bug is a good 'mirror' of the human body.

To find out if ER stress might be at play in Parkinson's, scientists analysed fruit flies with mutant forms of the pink1 or parkin genes.

These genes are also mutated in humans and result in hereditary versions of the disease causing shaking, trembling and difficulty walking.

Much like Parkinson's patients, flies with either mutation move more slowly and have weakened muscles.

The insects struggle to fly and they lose dopaminergic neurons in their brains - a classic feature of Parkinson's.

Researchers also found that the mutants experienced large amounts of ER stress and did not manufacture proteins as quickly as the non-mutants.

They were able to prevent neurodegeneration in mutant flies not only by reducing mitofusin, but also with chemicals that block the effects of ER stress.

The study was in the journal Cell Death and Disease.

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Scientists are close to finding a cure for Parkinson's disease

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SCIENTISTS are on the brink of finding a cure for Parkinson's disease after discovering what causes the illness and how it affects brain cells. Experts previously thought people who fell ill at a younger age than most who develop Parkinson's suffer from a poorly functioning 'mitochondria'.

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Frequently Asked Questions about Parkinson's | Parkinson's New Zealand

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Parkinson's New Zealand has 20 divisions and branches nationwide, as well as a National Office. Each division provides one or more Community Educators who are trained to help you and your family with your Parkinson's journey. They can provide support, information and advocacy through home visits or telephone calls.

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To become an acupuncturist you need to have a Bachelor of Health Science (Level 7) in either acupuncture or Chinese medicine. This degree is available from:

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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Parkinson's disease - symptoms, causes, treatment - Southern Cross NZ

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Parkinson's disease is a progressive brain disorder. Symptoms include tremors, stiffness and slowness of movement: causes, diagnosis, treatment.

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Welcome to Parkinson's NZ | Parkinson's New Zealand

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Founded in 1983, The Parkinson's New Zealand Charitable Trust is a community based, non-profit organisation, registered with the Charities Commission and reliant on funding from grants, bequests and donations. We have 20 divisions and branches supported by a National Office in Wellington.

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These increasing young-onset instances reinforce our view that more should be done to increase Parkinson's awareness across all sections of society

Lizzie Graham

These increasing young-onset instances reinforce our view that more should be done to increase Parkinson's awareness across all sections of society

Lizzie Graham

Sexuality and Parkinson's: the needs of caregivers

Tips for maintaining couple intimacy in Parkinson's
READ MORE

How virtual reality is giving Parkinson's patients a 'disease-free' Second Life

Second Life: a (virtual) world without Parkinson's
READ MORE

March 2018

Highlights: Fourth Annual Foxy Masquerade Ball
READ MORE

Does Bill Clinton have Parkinson's disease?

I've got Parkinson's and cancer: Billy Connolly's tear-jerking appeal

8 smart Parkinson's apps you need to try

These photos could change the way the world sees Parkinson's forever

3 incredible walking inventions that Parkinson's patients need to know about

4 days ago

Global Kinetics receives vital funding

Australian-based health company Global Kinetics has received a $AUS 7.75 million investment from the Australian Federal Government's Biomedical Translation Fund. The investment will be used to commercialise its Parkinson's KinetiGraph - a smartwatch-style device that continually tracks the involuntary movements of those living with the condition. In addition to the sum from the Australian government, Global Kinetics also announced they are to receive a grant from The Michael J Fox Foundation, Shake It Up Australia Foundation and Parkinson's Victoria. Mark Frasier, senior vice president of research programmes at The Michael J Fox Foundation, said: "The experience of Parkinson's varies day-to-day, hour-to-hour. An objective tool, such as the wearable PKG technology, that passively collects data on the experience of Parkinson's disease could give patients and their doctors greater insight to calibrate treatment plans and improve outcomes."

Learn more

2 weeks ago

Smartphone app detects severity of Parkinson's symptoms

A smartphone app- created by researchers from Johns Hopkins University, the University of Rochester Medical Centre and Aston University - can detect the severity of symptoms in people with Parkinson's, according to a recent study. The study, which appeared in medical journal 'JAMA', found that the HopkinsPD app generated severity score levels which strongly correlated with standard movement tests given by physicians. HopkinsPD is expected to help medical professionals analyse Parkinson's symptoms. Dr Ray Dorsey, neurologist at the University of Rochester, said: "Until these types of studies, we had very limited data on how people function on Saturdays and Sundays because patients don't come to the clinic. "We also had very limited data about how people with Parkinson's do at two o'clock in the morning or 11 o'clock at night because, unless they're hospitalised, they're generally not being seen in clinics at those times."

Read more

3 weeks ago

Could eating fish prevent Parkinson's disease?

A new study has found a link between the consumption of fish and long-term neurological health. The research, carried out by Chalmers University of Technology, Sweden, found that Parvalbumin - a protein found in several different types of fish - could prevent the formation of protein structures linked to Parkinson's disease. Pernilla Wittung-Stafshede, professor and head of chemical biology at Chalmers University of Technology, said: "Parvalbumin collects up the 'Parkinson's protein' and actually prevents it from aggregating, simply by aggregating itself first." Nathalie Scheers, who worked as a researcher on the study, said the time of year may affect the study's results: "Fish is normally a lot more nutritious at the end of the summer, because of increased metabolic activity. Levels of parvalbumin are much higher in fish after they have had a lot of sun, so it could be worthwhile increasing consumption during autumn."

Read more

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Two-year-old could be world's youngest person diagnosed with Parkinson's

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These increasing young-onset instances reinforce our view that more should be done to increase Parkinson's awareness across all sections of society These increasing young-onset instances reinforce our view that more should be done to increase Parkinson's awareness across all sections of society Tips for maintaining couple intimacy in Parkinson's READ MORE Second Life: a (virtual) world without Parkinson's READ MORE Highlights: Fourth Annual Foxy Masquerade Ball READ MORE Does Bill Clinton have Parkinson's disease?

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Coenzyme Q10 ( CoQ10) is a nutrient that occurs naturally in the body. CoQ10 is also in many foods we eat. CoQ10 acts as an antioxidant, which protects cells from damage and plays an important part in the metabolism.

Why do people take CoQ10?

Although CoQ10 plays a key role in the body, most healthy people have enough CoQ10 naturally. There is some evidence that adding more -- in the form of CoQ10 supplements -- may be beneficial. Increasing age and some medical conditions are associated with dropping levels of CoQ10. But in these cases, it's uncertain that adding CoQ10 will have an effect.

CoQ10 has been used to treat many different conditions. There's evidence that CoQ10 supplements can lower blood pressure slightly. CoQ10 is also used to treat heart failure and other heart conditions, possibly helping to improve some symptoms and lessen future cardiac risks when combined with regular medications, but the evidence is conflicting.

Though still controversial, some preliminary evidence suggests that CoQ10 may help to prevent or treat the adverse effects, such as muscle pains and liver problems, of taking statin-type cholesterol drugs.

Preliminary studies have shown that CoQ10 may slow, but not stop, the progression of Alzheimer's disease. Additional research is needed to confirm this effect.

CoQ10 has also been studied as a preventive treatment for migraine headaches, though it may take several months to work. It was also been studied for low sperm count, cancer, HIV, muscular dystrophy, Parkinson's disease, gum disease, and many other conditions. However, the research has not found any conclusive benefits. Although CoQ10 is sometimes sold as an energy supplement, there is no evidence that it will boost energy in a typical person.

How much CoQ10 should you take?

There is no established ideal dose of CoQ10. Studies have used doses of CoQ10 ranging from 50 milligrams to 1,200 milligrams in adults, sometimes split into several doses over the course of a day. A typical daily dose is 100 milligrams to 200 milligrams. Follow the instructions on the bottle or get advice from your doctor or a dietitian. Keep in mind that different supplement brands might have different ingredients and strengths.

Continued

Can you get CoQ10 naturally from foods?

The amounts of CoQ10 in found naturally in food is much lower than that found in supplements. Good food sources of CoQ10 include:

Cold water fish, like tuna, salmon, mackerel, and sardines

Vegetable oils

Meats

What are the risks of taking CoQ10?

Side effects from CoQ10 seem to be rare and mild. They include diarrhea, nausea, and heartburn.

Risks. People with chronic diseases such as heart failure, kidney or liver problems, or diabetes should be wary of using this supplement. CoQ10 may lower blood sugar levels and blood pressure. Doses of more than 300 milligrams may affect liver enzyme levels.

Interactions. People taking blood thinners and thyroid medications as well as chemotherapy should check with their doctors before using CoQ10 supplements.

Given the lack of evidence about its safety, CoQ10 supplements are not recommended for children or for women who are pregnant or breastfeeding.

Sources

SOURCES:
Paul M. Coates, PhD, director, Office of Dietary Supplements, National Institutes of Health, Bethesda, Md.
Longe, J., ed. The Gale Encyclopedia of Alternative Medicine, second edition, 2004.
Natural Standard Patient Monograph: "Coenzyme Q10."
Andrew Shao, PhD, vice president , Scientific & Regulatory Affairs, Council for Responsible Nutrition, Washington, D.C.
Paul R. Thomas, EdD, RD, scientific consultant, Office of Dietary Supplements, National Institutes of Health, Bethesda, Md.
Vandenberg, B. Current Atherosclerosis Reports, January 2010.
Mayo Clinic Drugs and Supplements: "Coenzyme Q10."

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Conenzyme Q10 (CoQ10): Should You Take Supplements?

# data[].attributes.attachment_link.description
Coenzyme Q10 ( CoQ10) is a nutrient that occurs naturally in the body. CoQ10 is also in many foods we eat. CoQ10 acts as an antioxidant, which protects cells from damage and plays an important part in the metabolism. Although CoQ10 plays a key role in the body, most healthy people have enough CoQ10 naturally.

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Diagnosis

No specific test exists to diagnose Parkinson's disease. Your doctor trained in nervous system conditions (neurologist) will diagnose Parkinson's disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination.

Your doctor may order tests, such as blood tests, to rule out other conditions that may be causing your symptoms.

Imaging tests - such as MRI, ultrasound of the brain, SPECT and PET scans - may also be used to help rule out other disorders. Imaging tests aren't particularly helpful for diagnosing Parkinson's disease.

In addition to your examination, your doctor may give you carbidopa-levodopa, a Parkinson's disease medication. You must be given a sufficient dose to show the benefit, as low doses for a day or two aren't reliable. Significant improvement with this medication will often confirm your diagnosis of Parkinson's disease.

Sometimes it takes time to diagnose Parkinson's disease. Doctors may recommend regular follow-up appointments with neurologists trained in movement disorders to evaluate your condition and symptoms over time and diagnose Parkinson's disease.

Treatment

Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised.

Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems.

Medications

Medications may help you manage problems with walking, movement and tremor. These medications increase or substitute for dopamine, a specific signaling chemical (neurotransmitter) in your brain.

People with Parkinson's disease have low brain dopamine concentrations. However, dopamine can't be given directly, as it can't enter your brain.

You may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms usually can continue to be fairly well-controlled.

Medications your doctor may prescribe include:

Carbidopa-levodopa. Levodopa, the most effective Parkinson's disease medication, is a natural chemical that passes into your brain and is converted to dopamine.

Levodopa is combined with carbidopa (Rytary, Sinemet), which protects levodopa from premature conversion to dopamine outside your brain, which prevents or lessens side effects such as nausea.

Side effects may include nausea or lightheadedness (orthostatic hypotension).

After years, as your disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane ("wearing off").

Also, you may experience involuntary movements (dyskinesia) after taking higher doses of levodopa. Your doctor may lessen your dose or adjust the times of your doses to control these effects.

Carbidopa-levodopa infusion. The U.S. Food and Drug administration approved a drug called Duopa in 2015. This medication is made up of carbidopa and levodopa. However, it's administered through a feeding tube that delivers the medication in a gel form directly to the small intestine.

Duopa is for patients with more advanced Parkinson's who still respond to carbidopa-levodopa, but who have a lot of fluctuations in their response. Because Duopa is continually infused, blood levels of the two drugs remain constant.

Placement of the tube requires a small surgical procedure. Risks associated with having the tube include the tube falling out or infections at the infusion site.

Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in your brain.

They aren't as effective as levodopa in treating your symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.

Dopamine agonists include pramipexole (Mirapex), ropinirole (Requip) and rotigotine (given as a patch, Neupro). A short-acting injectable dopamine agonist, apomorphine (Apokyn), is used for quick relief.

Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa, but also include hallucinations, sleepiness and compulsive behaviors such as hypersexuality, gambling and eating. If you're taking these medications and you behave in a way that's out of character for you, talk to your doctor.

MAO-B inhibitors. These medications include selegiline (Eldepryl, Zelapar) and rasagiline (Azilect). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO-B). This enzyme metabolizes brain dopamine. Side effects may include nausea or insomnia.

When added to carbidopa-levodopa, these medications increase the risk of hallucinations.

These medications are not often used in combination with most antidepressants or certain narcotics due to potentially serious but rare reactions. Check with your doctor before taking any additional medications with a MAO-B inhibitor.

Catechol-O-methyltransferase (COMT) inhibitors. Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.

Side effects, including an increased risk of involuntary movements (dyskinesias), mainly result from an enhanced levodopa effect. Other side effects include diarrhea or other enhanced levodopa side effects.

Tolcapone (Tasmar) is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.

Anticholinergics. These medications were used for many years to help control the tremor associated with Parkinson's disease. Several anticholinergic medications are available, including benztropine (Cogentin) or trihexyphenidyl.

However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.

Amantadine. Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson's disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson's disease to control involuntary movements (dyskinesias) induced by carbidopa-levodopa.

Side effects may include a purple mottling of the skin, ankle swelling or hallucinations.

Surgical procedures

Deep brain stimulation. In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce your Parkinson's disease symptoms.

Your doctor may adjust your settings as necessary to treat your condition. Surgery involves risks, including infections, stroke or brain hemorrhage. Some people experience problems with the DBS system or have complications due to stimulation, and your doctor may need to adjust or replace some parts of the system.

Deep brain stimulation is most often offered to people with advanced Parkinson's disease who have unstable medication (levodopa) responses. DBS can stabilize medication fluctuations, reduce or halt involuntary movements (dyskinesias), reduce tremor, reduce rigidity, and improve slowing of movement.

DBS is effective in controlling erratic and fluctuating responses to levodopa or for controlling dyskinesias that don't improve with medication adjustments.

However, DBS isn't helpful for problems that don't respond to levodopa therapy apart from tremor. A tremor may be controlled by DBS even if the tremor isn't very responsive to levodopa.

Although DBS may provide sustained benefit for Parkinson's symptoms, it doesn't keep Parkinson's disease from progressing.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

If you've received a diagnosis of Parkinson's disease, you'll need to work closely with your doctor to find a treatment plan that offers you the greatest relief from symptoms with the fewest side effects. Certain lifestyle changes may also help make living with Parkinson's disease easier.

Healthy eating

While there's no food or combination of foods proven to help in Parkinson's disease, some foods may help ease some of the symptoms. For example, eating foods high in fiber and drinking an adequate amount of fluids can help prevent constipation that is common in Parkinson's disease.

A balanced diet also provides nutrients, such as omega-3 fatty acids, that may be beneficial for people with Parkinson's disease.

Exercise

Exercising may increase your muscle strength, flexibility and balance. Exercise can also improve your well-being and reduce depression or anxiety.

Your doctor may suggest you work with a physical therapist to learn an exercise program that works for you. You may also try exercises such as walking, swimming, gardening, dancing, water aerobics or stretching.

Parkinson's disease can disturb your sense of balance, making it difficult to walk with a normal gait. Exercise may improve your balance. These suggestions may also help:

Try not to move too quickly.

Aim for your heel to strike the floor first when you're walking.

If you notice yourself shuffling, stop and check your posture. It's best to stand up straight.

Look in front of you, not directly down, while walking.

Avoiding falls

In the later stages of the disease, you may fall more easily. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help:

Make a U-turn instead of pivoting your body over your feet.

Distribute your weight evenly between both feet, and don't lean.

Avoid carrying things while you walk.

Avoid walking backward.

Daily living activities

Daily living activities - such as dressing, eating, bathing and writing - can be difficult for people with Parkinson's disease. An occupational therapist can show you techniques that make daily life easier.

Alternative medicine

Some types of alternative medicine may help people with Parkinson's disease, including:

Coenzyme Q10. Early research suggested that high doses of coenzyme Q10 - a readily available supplement - may be beneficial for people in the early stages of Parkinson's disease. However, the benefits appear to depend on taking the supplement for 16 months or longer.

Massage. Massage therapy can reduce muscle tension and promote relaxation. These services, however, are rarely covered by health insurance.

Acupuncture. During an acupuncture session, a trained practitioner inserts tiny needles into many specific points on your body, which may reduce your pain.

Tai chi. An ancient form of Chinese exercise, tai chi employs slow, flowing motions that may improve flexibility, balance and muscle strength. Tai chi may also prevent falls. Several forms of tai chi are tailored for people of any age or physical condition.

A study showed tai chi may improve the balance of people with mild to moderate Parkinson's disease more than stretching and resistance training.

Yoga. In yoga, gentle stretching movements and poses may increase your flexibility and balance. You may modify most poses to fit your physical abilities.

Alexander technique. This technique - which focuses on muscle posture, balance and thinking about how you use muscles - may reduce muscle tension and pain.

Meditation. In meditation, you quietly reflect and focus your mind on an idea or image. Meditation may reduce stress and pain and improve your sense of well-being.

Music or art therapy. Music or art therapy may help you to relax. Music therapy helps some people with Parkinson's disease to improve their walking and speech. Participating in art therapy, such as painting or ceramics, may improve your mood and help you relax.

Pet therapy. Having a dog or cat may increase your flexibility and movement and improve your emotional health.

Coping and support

Living with any chronic illness can be difficult, and it's normal to feel angry, depressed or discouraged at times. Parkinson's disease, in particular, can be profoundly frustrating, as walking, talking and even eating become more difficult and time-consuming.

Depression is common in people with Parkinson's disease. But antidepressant medications can help ease the symptoms of depression, so talk with your doctor if you're feeling persistently sad or hopeless.

Although friends and family can be your best allies, the understanding of people who know what you're going through can be especially helpful. Support groups aren't for everyone. However, for many people with Parkinson's disease and their families, support groups can be a good resource for practical information about Parkinson's disease.

Also, groups offer a place for you to find people who are going through similar situations and can support you.

To learn about support groups in your community, talk to your doctor, a Parkinson's disease social worker or a local public health nurse. Or contact the National Parkinson Foundation or the American Parkinson Disease Association.

You and your family may also benefit from talking to a mental health professional (psychologist) or social worker trained in working with people who have chronic conditions.

Preparing for your appointment

You're likely to first see your primary care doctor. However, you may then be referred to a doctor trained in nervous system disorders (neurologist).

Because there's often a lot to discuss, it's a good idea to prepare for your appointment. Here's some information to help you get ready for your appointment and what to expect from your doctor.

What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins and supplements that you're taking.

Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For Parkinson's disease, some basic questions to ask your doctor include:

What's the most likely cause of my symptoms?

Are there other possible causes?

What kinds of tests do I need? Do these tests require any special preparation?

How does Parkinson's disease usually progress?

Will I eventually need long-term care?

What treatments are available, and which do you recommend for me?

What types of side effects can I expect from treatment?

If the treatment doesn't work or stops working, do I have additional options?

I have other health conditions. How can I best manage these conditions together?

Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did you first begin experiencing symptoms?

Do you have symptoms all the time or do they come and go?

Does anything seem to improve your symptoms?

Does anything seem to make your symptoms worse?

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No specific test exists to diagnose Parkinson's disease. Your doctor trained in nervous system conditions (neurologist) will diagnose Parkinson's disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination.

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Generic Name: Carbidopa and Levodopa Tablets (KAR bi DOE pa/LEE voe DOE pa)
Brand Name: Sinemet

Medically reviewed on May 2, 2018

Uses of Sinemet:

It is used to treat Parkinson's disease.

It is used to treat signs like Parkinson's disease caused by other health problems.

It may be given to you for other reasons. Talk with the doctor.

What do I need to tell my doctor BEFORE I take Sinemet?

If you have an allergy to levodopa, carbidopa, or any other part of Sinemet (carbidopa and levodopa tablets).

If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

If you have any of these health problems: Glaucoma, a skin lump or growth, or a history of skin cancer.

If you are taking any of these drugs: Reserpine or tetrabenazine.

If you have taken certain drugs used for low mood (depression) like isocarboxazid, phenelzine, or tranylcypromine or drugs used for Parkinson's disease likeselegiline or rasagiline in the last 14 days. Taking Sinemet (carbidopa and levodopa tablets) within 14 days of those drugs can cause very bad high blood pressure.

If you are taking another drug that has the same drug in it.

This is not a list of all drugs or health problems that interact with Sinemet (carbidopa and levodopa tablets).

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take Sinemet (carbidopa and levodopa tablets) with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take Sinemet?

Tell all of your health care providers that you take Sinemet (carbidopa and levodopa tablets). This includes your doctors, nurses, pharmacists, and dentists.

Avoid driving and doing other tasks or actions that call for you to be alert until you see how Sinemet (carbidopa and levodopa tablets) affects you.

To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down. Be careful going up and down stairs.

This medicine may affect certain lab tests. Tell all of your health care providers and lab workers that you take Sinemet (carbidopa and levodopa tablets).

Have blood work checked as you have been told by the doctor. Talk with the doctor.

If you have high blood sugar (diabetes), talk with your doctor about which glucose tests are best to use.

Have your eye pressure checked. Talk with your doctor.

This medicine may "wear off" as the time for your next dose gets closer. Tell your doctor if this happens and it bothers you.

Talk with your doctor before you drink alcohol or use other drugs and natural products that slow your actions.

The chance of a type of skin cancer called melanoma may be raised in people with Parkinson's disease. It is not known if Sinemet (carbidopa and levodopa tablets) may also raise the chance. Have skin exams while you take Sinemet (carbidopa and levodopa tablets). Talk with your doctor.

Some products may cause a dark red, brown, or black color to appear in your saliva, urine, or sweat. This is not harmful but may discolor your clothes.

Some people have fallen asleep during activities like driving, eating, or talking. Some people did not feel sleepy and felt alert right before falling asleep. This has happened up to 1 year after Sinemet (carbidopa and levodopa tablets) was started. If you fall asleep during activities, do not drive or do other tasks or actions that call for you to be alert while you take Sinemet (carbidopa and levodopa tablets). Call your doctor right away if this happens or you feel very sleepy.

Neuroleptic malignant syndrome (NMS) is a very bad and sometimes deadly health problem that has happened when Sinemet (carbidopa and levodopa tablets) was stopped all of a sudden. NMS has also happened when the dose of Sinemet (carbidopa and levodopa tablets) was lowered. Call your doctor right away if you have any fever, muscle cramps or stiffness,dizziness, very bad headache, confusion, change in thinking, fast heartbeat, heartbeat that does not feel normal, or are sweating a lot.

Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using Sinemet (carbidopa and levodopa tablets) while you are pregnant.

Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

How is this medicine (Sinemet) best taken?

Use Sinemet (carbidopa and levodopa tablets) as ordered by your doctor. Read all information given to you. Follow all instructions closely.

Take with or without food.

If you take an iron product or a multivitamin that has iron, ask your doctor or pharmacist how to take it with Sinemet (carbidopa and levodopa tablets). Iron may lower how well your body is able to absorb Sinemet (carbidopa and levodopa tablets).

Diets high in protein, fat, or calories may lower how well your body absorbs Sinemet (carbidopa and levodopa tablets); tell your doctor if you have a diet like this or if you will be changing your diet. Talk with your doctor.

Do not stop taking Sinemet (carbidopa and levodopa tablets) all of a sudden or lower your dose without calling your doctor. Side effects may happen. Talk with your doctor.

Take even during sign-free periods.

Keep a diary of your signs.

Keep taking Sinemet (carbidopa and levodopa tablets) as you have been told by your doctor or other health care provider, even if you feel well.

Take Sinemet (carbidopa and levodopa tablets) at the same time of day.

To gain the most benefit, do not miss doses.

What do I do if I miss a dose?

Take a missed dose as soon as you think about it.

If it is close to the time for your next dose, skip the missed dose and go back to your normal time.

Do not take 2 doses at the same time or extra doses.

See also: Dosage Information (in more detail)

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Signs of low mood (depression), thoughts of killing yourself, nervousness, emotional ups and downs, thinking that is not normal, anxiety, or lack of interest in life.

Change in the way you act.

Hallucinations (seeing or hearing things that are not there).

Feeling confused.

Strong urges that are hard to control (such as eating, gambling, sex, or spending money).

A skin lump or growth.

Change in color or size of a mole.

Trouble controlling body movements that is new or worse.

Throwing up blood or throw up that looks like coffee grounds.

Black, tarry, or bloody stools.

Belly pain.

Chest pain or pressure or a fast heartbeat.

A heartbeat that does not feel normal.

Fever or chills.

Sore throat.

Any unexplained bruising or bleeding.

Very bad dizziness or passing out.

Very bad headache.

Dark urine or yellow skin or eyes.

Change in eyesight, eye pain, or very bad eye irritation.

Shortness of breath.

Feeling very tired or weak.

What are some other side effects of Sinemet?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

See also: Side effects (in more detail)

If OVERDOSE is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out Sinemet?

Store at room temperature.

Store in a dry place. Do not store in a bathroom.

Protect from light.

Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.

Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

Consumer information use

If your symptoms or health problems do not get better or if they become worse, call your doctor.

Do not share your drugs with others and do not take anyone else's drugs.

Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.

Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.

Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about Sinemet (carbidopa and levodopa tablets), please talk with your doctor, nurse, pharmacist, or other health care provider.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medical Disclaimer

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Sinemet: Indications, Side Effects, Warnings - Drugs.com

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Generic Name: Carbidopa and Levodopa Tablets (KAR bi DOE pa/LEE voe DOE pa) Brand Name: Sinemet Medically reviewed on May 2, 2018 It is used to treat Parkinson's disease. It is used to treat signs like Parkinson's disease caused by other health problems. It may be given to you for other reasons.

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This year, news broke that more than half of British MPs are backing a call to legalize marijuana for medical use. Now, many users are coming forward to voice support for the measure. One such supporter, 55-year old Ian Frizell, took to YouTube to demonstrate how cannabis has dramatically improved his life.

Frizell suffers from Parkinson's Disease, which causes frightening symptoms such as full-body tremors and Dystonia, which causes the muscles in his foot to curl over, becoming unusable. Frizell explains that earlier this year, he underwent brain stimulation surgery to implant a medical device that masks the effects of Parkinson's.

Frizell said he wanted to show how even a small dose of medical marijuana takes quick and positive effects on his condition. First, he stopped taking his prescription medication, and turned off his brain stimulation device.

"What you are seeing here is my Parkinson's tremor with absolutely no medication whatsoever. I cannot tolerate the prescription medication for Parkinson's disease. They make me feel extremely unwell," Ian explained.

Truth be told, about 10 seconds later, Frizell began tremoring with violent intensity. Frizell then self-medicates by vaping 30mg of weed. The results are completely mind-blowing. Not only does his tremoring stop, he says he feels more relaxed and his symptoms have totally subsided.

"My tremor has calmed down significantly. In fact, it's almost completely under control. The sense of relief is overwhelming.

Frizell also explained that his Dystonia had lessoned considerably and his voice was stronger, making it easier to get words out. Watch the whole video, which is truly impressive, here.

There's no doubt that cases like Frizell's could sway Parliament's decision to legalize medical marijuana, but what does science say about Parkinson's and cannabis?

In 2004, The Movement Disorders Journal published a study that showed that 45.9% of Parkinson's suffers showed mild or substantial alleviation of all their PD symptoms after medical marijuana use, 30.6% showed improvement of tremors, 44.7% showed improvement of bradykinisia, or slowness of movement. Additionally, patients who continued use for 3 months after the study showed significantly more alleviation of their symptoms.

It's not crazy to think that cannabis could have positive results for PD sufferers: there are cannabinoid receptors in the brain's basal ganglia, which is also an area important to Parkinson's disease. Thus, when THC goes to the brain, it also goes to areas where Parkinson's is present. As for UK's legalization process, the chairman of the group leading the way towards Parliment's approval said that the refusal to acknowlege cannabis' medicinal value is "irrational."

Claire Downs is a writer and comedian based out of Los Angeles. She's written for Nickelodeon, VH1, Funny or Die, and Hello Giggles. You can follow her on Twitter @clairecdowns. She prefers Indica to Sativa, in case you're wondering.

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Mind-Blowing Video Shows Cannabis' Effects on Parkinson's Symptoms - Health | MERRY JANE

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This year, news broke that more than half of British MPs are backing a call to legalize marijuana for medical use. Now, many users are coming forward to voice support for the measure. One such supporter, 55-year old Ian Frizell, took to YouTube to demonstrate how cannabis has dramatically improved his life.

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With medical marijuana now legalized in 29 states and Washington, D.C., it is obvious that there is strong interest in its therapeutic properties. Researchers are testing marijuana, which is also called cannabis, as a treatment for many illnesses and diseases, including neurological conditions, with Parkinson's disease (PD) high on the list. But despite several clinical studies, it has not been demonstrated that cannabis can directly benefit people with PD.

The Science Behind Marijuana

What is the science and pharmacology behind marijuana, and can it be used to treat Parkinson's symptoms?

The endocannabinoid system is located in the brain and made up of cannabinoid receptors (a receptor is molecular switch on the outside of a cell that makes something happen inside a cell when activated) that are linked to neurons (brain cells) that regulate thinking and some body functions.

Researchers began to show enthusiasm to study cannabis in relation to PD after people with PD gave anecdotal reports and posted on social media as to how cannabis allegedly reduced their tremors. Some researchers think that cannabis might be neuroprotective - saving neurons from damage caused by PD.

Cannabinoids (the drug molecules in marijuana) have also been studied for use in treating other symptoms, like bradykinesia Slowness of movement. (slowness caused by PD) and dyskinesia (excess movement caused by levodopa). Despite some promising preclinical findings, researchers have not found any meaningful or conclusive benefits of cannabis for people with PD.

Researchers issue caution for people with PD who use cannabis because of its effect on thinking. PD can impair the executive function - the ability to make plans and limit risky behavior. People with a medical condition that impairs executive function should be cautious about using any medication that can compound this effect.

The Pharmacology of Cannabis

Marijuana contains more than 100 neuroactive chemicals that work with two types of cannabinoid receptors, type 1 (CB1) located in the brain and type 2 (CB2) located in the brain and peripheral immune system. Cannabinoids have powerful, indirect effects on these receptors, but researchers are unsure how. People with PD have less CB1 receptors than people who do not have PD. A boost to the CB1 receptor through an agonist, like marijuana, can improve tremors and may alleviate dyskinesia. Similarly, the other receptor, CB2, is also being studied to determine if it can modify the disease or provide neuroprotective benefits. However, a unified hypothesis does not currently exist for either receptor because there is too much conflicting data on the effectiveness of cannabinoids and these receptors.

Cannabis can contain two different types of molecules that interact with cannabinoid receptors: agonists and antagonists. An agonist is a drug that attaches to the same receptor as a natural chemical and causes the same effect. A dopamine agonist is a drug that is not dopamine, but attaches to the dopamine receptor. An antagonist is different as it attaches to the receptor, but blocks the action of the natural chemical. Medical marijuana can contain both cannabinoid agonists and antagonists. Recreational marijuana use is derived from its effects on agonists.

The varying amounts of cannabinoid agonists and antagonists in different marijuana plants makes cannabis studies difficult to conduct. When researchers study the effects of a medication, dosages are controlled and often set to a specific number of milligrams. When testing medical marijuana, the dosage administered can vary dramatically depending on the plant and method of administration.

Delta-9-tetrahydrocannibinol (THC)

THC is a primary component of marijuana. Cannabidiol is the other primary component. THC has a long latency of onset and cannot be easily measured for a therapeutic or medicinal dose. Medical marijuana studies primarily provide participants with THC and/or cannabidiol as a capsule, nasal spray or liquid formulation.

PD-Related Medicinal Marijuana Trials

The use of cannabinoids has been suggested to help with managing neurological and non-neurological conditions. Literature on medical marijuana is incredibly varied. Studies have not clearly supported the use of marijuana for PD. The clinical studies of cannabis as a PD treatment that have been conducted did not use the clinical trial A research study in humans that aims to test a new intervention - this could be a drug, surgery or therapy like exercise or diet guidelines - to make sure it is effective and safe. gold standard of a double blind, placebo controlled trial design. Some studies had as few as five subjects.

While some results have been positive, the effects of medical marijuana are probably not completely understood, which is why more studies, especially those with more subjects, are needed. Most doctors don't support study results because these studies do not meet minimum research standards.

Below are several PD-related medical marijuana studies that have been conducted to evaluate the use of cannabinoids:

Risks and Benefits for People with PD

There are risks and benefits associated with the use of cannabis for people with PD. Benefits include a possible improvement in anxiety A feeling of nervousness, worried thoughts and physical distress., pain management, sleep dysfunction, weight loss and nausea. Potential adverse effects include: impaired cognition (impairment in executive function), dizziness, blurred vision, mood and behavioral changes, loss of balance and hallucinations. Chronic use of marijuana can increase risk of mood disorders and lung cancer.

Medical Marijuana and Legislation by State

Washington, D.C., and 29 states passed legislation allowing the use of marijuana-based products for medical purposes. Three of those states (Minnesota, New York and Ohio) do not allow it to be smoked. In some states patients must register to possess and use cannabis. Other states require patients to acquire a document from a physician stating that the patient has an approved condition. Under federal law doctors cannot prescribe cannabis, but many states authorize them to issue certifications that allow patients to obtain medical marijuana.

PD is a qualifying condition for medical marijuana in: Arizona, Connecticut, Florida, Illinois, Maine, New Mexico, New York, Pennsylvania and Rhode Island.

Medical marijuana is legal in: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, West Virginia, and Washington, D.C. In Texas, medical marijuana is only approved for people with epilepsy.

Parkinson's Foundation Centers of Excellence and Medicinal Marijuana

The Parkinson's Foundation, in partnership with Northwestern University researchers, studied attitudes about cannabis at 40 Centers of Excellence. To the best of our knowledge, this is the first study to provide data on the practices, beliefs and attitudes of expert PD physicians concerning cannabis use.

The results were interesting: most experts said they knew what cannabis did, but disagreed on the details. While there is no general agreement on what the benefits might be for people with PD, the survey confirmed that cannabis is a popular subject within Parkinson's Foundation centers as 95 percent of neurologists reported patients have asked them to prescribe it.

Cannabis study results also included:

Only 23 percent of physicians had any formal education on the subject of cannabis (such as a course or lecture), thus 93 percent of physicians want cannabis taught in medical school.

Physicians reported that 80 percent of their patients with PD have used cannabis.

Only 10 percent of physicians have recommended the use of cannabis to patients with PD.

In terms of memory: 75 percent of physicians felt that cannabis would have negative effects on short-term memory and 55 percent felt that cannabis could have negative effects on long-term memory

Only 11 percent of physicians have recommended use of cannabis in the last year

This graph shows how physicians expect cannabis would improve, worsen, or show no effect to PD-related symptoms given their expertise and observations of patients with PD.
The study emphasized that physicians would be more apt to the use of medical marijuana as a treatment if the drug was approved through regulation instead of legislation. Nearly all medications are only approved after passing a science-based evaluation proving their effectiveness in a process overseen by the U.S. Food and Drug Administration. Since cannabis has been approved through legislation rather than regulation, there are no labels, dosage recommendations or timing instructions that physicians can reference.

Is Medical Marijuana an Option for Me?

What's next for a person with PD who wants to know if medical marijuana is an option? "Marijuana should never be thought of as a replacement for dopaminergic and other approved therapies for PD," said Dr. Michael S. Okun, the Parkinson's Foundation National Medical Director.

Research is still needed to determine how medical marijuana should be administered and how its long-term use can affect symptoms of PD. To keep patients safe, states that legalize medical marijuana will eventually need to develop training programs for doctors and medical teams that prescribe medical marijuana. Consult your doctor to see if medical marijuana is an option for you.
Page reviewed by Dr. Bhavana Patel, Movement Disorders Fellow at the University of Florida, a Parkinson's Foundation Center of Excellence.

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With medical marijuana now legalized in 29 states and Washington, D.C., it is obvious that there is strong interest in its therapeutic properties. Researchers are testing marijuana, which is also called cannabis, as a treatment for many illnesses and diseases, including neurological conditions, with Parkinson's disease (PD) high on the list.

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The term alternative therapy, in general, is used to describe any medical treatment or intervention that has not been scientifically documented or identified as safe or effective for a specific condition. Alternative therapy encompasses a variety of disciplines including acupuncture, guided imagery, chiropractic, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others.

Vitamin E, coenzyme Q10, and uric acid are examples of alternative treatments that have been studied as treatments for Parkinson's disease. However, they were found not to be effective or may even have harmful side effects.

Other Alternative Treatments for Parkinson's Disease?

Exercise. Although not necessarily an "alternative therapy," exercises like Tai chi and yoga can lower stress, help you to be more relaxed, and increase energy, balance, and flexibility. In general, exercise is a safe, effective and easy way to improve well-being. But, check with your doctor first.

Diet. By following your doctor's and dietitian's nutritional guidelines, you can look and feel better.

Positive Attitude. Having a positive outlook cannot cure Parkinson's disease, but it can lower stress and help you feel better!

How Can I Know If an Alternative Treatment Is Safe and Effective?

Alternative treatments can be helpful in some cases, yet some therapies can be ineffective, costly, and even dangerous. The best way to evaluate your options is to become educated. Ask yourself the following questions:

What is the treatment?

What does it involve?

How does it work?

Why does it work?

Are there any risks?

What are the side effects?

Is it effective? (Ask for evidence or proof.)

How much does it cost?

Once you answer these questions, weigh your options and decide whether the benefits outweigh the risks.

If you do decide to try an alternative treatment, make sure your health is protected. Do not take the claim at face value: contact reliable organizations and discuss the therapy. Talk to others in a support group, your family and friends; although they may not always be supportive, they can help you make an educated, objective decision.

Discuss the therapy with your doctor. Make sure your doctor knows what therapy you are considering so he or she can discuss possible interactions and/or side effects with your current treatments. He or she can also provide you with information on other patients who may have tried the same therapy.

Continued

Contact the Better Business Bureau and thoroughly research the background of the therapy provider. Determine how long they have been providing this therapy, what credentials they have, and what their philosophy of treatment is. Avoid therapy providers who refuse or are reluctant to work with your doctor. Be sure that the provider is willing to refer patients to a conventional doctor when necessary.

And, lastly, make sure you know the cost of treatment up front. Most alternative therapies are not covered by your insurance.

Alternative Treatment Red Flags to Look for Include:

How the product/provider is promoted. Be cautious if products or providers are promoted through: telemarketers; direct mailings; infomercials; ads disguised as valid news articles; ads in the back of magazines.

Big claims. If a provider or product claims to be a "cure" for Parkinson's disease, or gives outrageous claims, be cautious.

Source. Beware if the product is only being offered through one doctor or manufacturer.

Ingredients. Make sure all of the active ingredients are listed. Do not trust "secret formulas."

Testimonials. Keep in mind that testimonials are only given by those who are satisfied with the product. And, if the ad says, "paid endorsement," know that the person is getting compensated to say what the manufacturer wants them to say.

WebMD Medical Reference Reviewed by Richard Senelick, MD on September 02, 2016

Sources

SOURCES:

National Parkinson Foundation: "Complementary Treatment."

Parkinsons.org: "Parkinson's Disease Alternative Medicine."

Mayo Clinic: "Parkinson's Disease: Alternative Medicine."

Parkinson's Disease Society: "Complementary Therapies and Parkinson's Disease."

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Alternative Therapies for Parkinson's Disease

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The term alternative therapy, in general, is used to describe any medical treatment or intervention that has not been scientifically documented or identified as safe or effective for a specific condition. Alternative therapy encompasses a variety of disciplines including acupuncture, guided imagery, chiropractic, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others.

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Parkinson's disease ( PD) is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms generally come on slowly over time. Early in the disease, the most obvious are shaking, rigidity, slowness of movement, and difficulty with walking. Thinking and behavioral problems may also occur.

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Parkinson's disease - Diagnosis and treatment - Mayo Clinic

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There's no cure for this progressive movement disorder, but treatments can help significantly improve your symptoms.

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What is Parkinson's? | Parkinson's New Zealand

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Although we know a lot about the changes in the nerve cells of the brain in Parkinson's, we do not yet know what causes or triggers the development of Parkinson's. Symptoms can be treated but there is no known cure. Researchers across the world continue to investigate new treatments.