Herbal Drugs in Parkinsons Disease -A Review

 Synonyms: Horse, Broad, Windsor,
English Dwarf Bean, Tick, Pigeon, Bell,
Haba, Feve and Silkworm beans.

Vicia faba
L. is a member of the Fabaceae (pea) family. California is
noted for its culture.  Fava beans are a relative of vetch, a determinate type with
erect, coarse stems and large leaves without climbing tendrils. It grows to be
a bushy plant, two to seven feet tall. The white or purplish flowers are born
in clusters on short stalks in the axils of the leaves. The large-seeded
varieties bear 1 or 2 pods at each node while the small-seeded types are
produced from 2-5 pods. The pods produced are up to 18 inches long and contain
from 3-12 large beans. There are about 15 pods per stalk on the large types and
60 pods on plants of the small-seeded varieties. When stored under favorable
conditions, most bean seeds have a life expectancy of 3 years. It is similar in
size to the lima bean and is native to the Mediterranean region, especially Italy and Iran. It is
one of the oldest cultivated plants known, with its culture extending back to
prehistoric times.

The
beans alone are also good - 3 ½ ounces (98 grams) of cooked fresh beans contain
56 calories, 20 grams carbohydrates, 5 grams protein, 2 grams fiber, and
substantial amounts of iron, magnesium, and vitamin C, besides levodopa, fava beans are rich in
valuable nutrients. Fava pods with beans are a good
source of iron, magnesium, potassium, zinc, copper, selenium, and many
vitamins.

Fava beans in Parkinson disesase :

Some
small studies have shown that the levodopa in fava beans can help control the symptoms of Parkinson disesase, just
as medications containing levodopa do. In fact, a few
people report that the effects from fava last longer
than the effects from medications. Some researchers believe fava
beans may contain other substances besides levodopa
that could be helpful for PD symptoms. However, although some people report
good effects, others find no antiparkinson effect
from fava beans at all; and still others report
adverse effects, such as nausea and dyskinesia. Much
more research needs to be done to determine how effective fava
beans may be.

In
the western countries, where fava beans are less well
known, there is also less understanding of their properties, particularly with
regard to their levodopa content. Because different
species of fava plants have varying amounts of levodopa, it's possible to get either too much or too
little levodopa - there is no "standard" or
exact amount that can be surely obtained. Too little levodopa
will not relieve PD symptoms; and too much levodopa
can cause overmedication effects, such as dyskinesia
- particularly if other PD medications are being used at the same time. Also,
the levodopa can cause nausea in some people. Allergies. In a few people, raw fava beans
can produce an allergic reaction, including discomfort and occasionally, coma.
Cooking the beans, however, may prevent allergic reactions.

Monoamine oxidase
inhibitor (MAOI) use. Another consideration
is the use of MAOI medications, including isocarboxazid
(Marplan); phenelzine (Nardil); tranylcypromine (Parnate); and selegiline (deprenyl, Carbex, Eldepryl). MAOIs taken in
combination with pressor agents (foods high in
dopamine, tyramine and phenylethylamine)
can bring about a dangerous, and sometimes fatal, increase in blood pressure. Levodopa in medications or in fava
can convert to dopamine in the bloodstream. It should be noted that selegiline is a different type of MAOI (MAOI-type B), and
in the amount normally used by people with PD (10 mg daily), it is not thought
to pose a risk when used with dopamine. However, people using any MAOI should
discuss foods containing pressor agents with their
physicians and dietitians.

Favism
(G6PD deficiency). Favism is an
inherited disease in which a person lacks an enzyme called glucose-6-phosphate dehydrogenase (G6PD). When these people eat fava beans, they develop a condition called hemolytic
anemia. This anemia causes red blood cells to break apart and block blood
vessels. When such blockage occurs in the kidneys, it can result in kidney
failure and even death. Although favism is usually
detected in childhood, adults can be affected as well. G6PD deficiency is rare, occurring mostly among people of Mediterranean,
African, and Southeast Asian descent, but others can be affected as well. In
1913, Guggenheim first isolated dihydroxyalanine in it’s laevorotatory form after it’s extraction from Vicia beans. There are anecdotal reports that patients with
PD will benefit from meals of broad beans and that the response to the beans may
even be better than conventional L-dopa medication in some cases. Recent
studies have established the dose-response relation and L-dopa absorption
characteristics of Vicia beans. There is sufficient
L-dopa in the bean to be pharmacologically active in PD. The beans are a
natural food, which contains L-dopa, and physicochemical form different from
that of a tablet formulation and may thus have a use in the management of
Parkinson’s motor fluctuations. In single dose studies, researchers have
evaluated patients with pronounced “on-off” motor oscillations for the
beneficial effect. Clear responses to L-dopa occur in such cases and their
magnitude and time course can be accurately quantified by serial objective
motor assessments. The magnitude of response (difference between ‘off’ and ‘on’
states) is almost identical. The bean meal produces a longer response, which
seems to be explained by a larger L-dopa dose and higher plasma
concentration.  Natural sources of L-dopa
cannot compete with tablet formulations for convenience and predictable
availability. However, the beans do have some potential advantages in reducing
the interaction between oral L-dopa medication and diet. Rather than simply
restricting oral protein intake, a diet that substitutes the beans for other
foods that contain protein, in conjunction with the conventional L-dopa or carboxylase inhibitor medication, may have a stabilizing
effect on motor fluctuations and reduce food-induced ‘off’ phases. The beans
are a relatively rich protein source (if both legumes and pods are ingested),
which has a positive effect on both plasma L-dopa concentration and motor
function.

3.Gingko biloba ^19-24

Synonyms:   Maidenhair tree

The
tree is incredibly ancient (fossilized remains have been dated as long as 180
million years old) and is the only species in it’s
family (Gingkoaceae) which is still existing (the
other 6 species which are extinct). It is a deciduous tree, which can live over
a 1000 years in the right conditions. Gingko in Japanese means ‘silver apricot’
(which refers to the fruit).

Anti-ageing, anti-allergenic, anti-asthmatic,
anti-inflammatory, anti-oxidant, antiPAF
(platelet-activating factor), cardio-protective, circulatory stimulant
(especially to the brain and limbs, lowers cholesterol.

Asthma: The anit-PAF action decreases allergic reactions leading to
less broncho-constriction and inflammation in the
lungs. This eases chest tightness and wheezing. Dementia: It can be used
to lessen the symptoms of Alzheimer’s disease, senile dementia and Parkinson’s
disease. Deteriorating vision: This can be helped if the problem is due
to a circulatory disorder affecting the retina of the eye. It may help senile
macular degeneration  (which
may occur in PD). Disordered limb sensations: Problems with limbs such
as feeling of coldness, Cramping, numbness and tingling maybe helped. Impaired
mental and general cerebral functioning: Gingko can improve alertness,
communication, concentration, memory, and orientation and reduce
absent-mindedness, anxiety, confusion, dizziness and fatigue, particularly in
older people.

Stroke
recovery: Gingko can speed up the time to regain normal functioning. Tinnitus
and hearing impairment: Reduced hearing ability and the unpleasant noises  heard in
tinnitus may be helped due to improving circulation within the ear and the
brain.

4.Ginseng ^25-30

Synonym : Panax

Korean
Ginseng is also known by the names Asian Ginseng, Asiatic Ginger, and Chinese
Ginseng. Korean Ginseng is a deciduous perennial shrub whose fleshy root
requires 4-6 years of cultivation to reach maturity. Its name comes from the
Chinese "jen shen,"
which means, "man root," so-named because some roots have limb-like
branches resembling arms and legs. Because the root has a human-like shape, it
is considered by Orientals to be an overall body tonic. Traditionally, the wild
root was consumed to vitalize, strengthen, and rejuvenate the entire body.
Widely cultivated, Korean Ginseng is now used as a natural preventive,
restorative remedy and valued for its adaptogenic
properties. Korean Ginseng is more stimulating and increases the
"yang" energy, while American Ginseng
(Panax quinquefolium)
increases the "yin" energy. Korean Ginseng is considered most
suitable for males and for older people. Used for centuries in China, Korean
Ginseng was believed to be and anti-aging herb. Today, Ginseng is a favorable
herb because of its ability to be used long-term without toxic effects on the
body. Korean Ginseng contains adaptogens that have
been known to return the body's system levels back to normal. By equalizing the
system levels in the body, Korean Ginseng has been used to lower cholesterol, balance the metabolism, increase energy
levels, and stimulate the immune system. It
has also been used to alleviate fatigue and
reduce nervousness & stress on the body. Korean Ginseng also increases
oxygenation to the cells and tissues, promoting detoxification, and stimulating
the regeneration of damaged cells. For this reason, Korean Ginseng is the
popular choice because it enhances the feeling of overall well being by
stimulating the nervous system, brain, and heart, as well as healthy liver functions.

The
herb "ginseng"
is actually several different types of plants, mainly Korean or
Asian ginseng (Panax ginseng), Siberian ginseng (Eleutherococcus senticosus), and
American ginseng (Panax quinquefolius).
Panax ginseng has
been an important herbal remedy in traditional Chinese medicine for thousands
of years, where it has been used primarily as a treatment for weakness and
fatigue.

Ginseng
roots have been found recently to help protect against cancer, cardiovascular
disease, and stress. These health-promoting effects are thought to be a result
of high levels of antioxidants in ginseng called ginsenosides,
of which there are 28 identified in American ginseng Now, a new study builds
upon memory-improving research on ginseng and shows that ginseng may help
protect your brain from breaking down as you get older. In a recent study,
researchers sought to find out whether ginseng, particularly the ginsenosides, could protect rats from a toxin that severely
impairs movement and loss of neurons in the brain, they found that the leaves
and stems preparation, which has greater levels of the panaxadiols
(35.8% of Rb1, Rb3 and Rd), had the brain-protecting effects whereas the root preparation
(26.9% of Rb1, Rb3 and Rd) had no protective effect. For the researchers, “the
results suggest that the Rb extract may prevent
[nerve damage] in Huntington's disease or other neurological disorders.

5.Ayahuasca ^31-37

          (Banisteriopsis caapi)

Both Banisteriopsis caapi and Banisteriopsis inebrians are used as the main
ingredient in ayahuasca. Both of these species are lianas, with smooth, brown
bark and dark green, chartaceous, ovate- anceolate leaves. These leaves are
about 18 cm in length and 5-8 cm wide. The inflorescence is many flowered,
with these small flowers being pink or rose-colored. The fruit is a samara
with wings about 3.5 cm long. B. inebrians differs form B. caapi mainly in
it’s thicker, ovate, more attentuate leaves and in the shape of the samara
wings. B. caapi climbs up adjacent tropical forest trees and keeps climbing
until its flowers are exposed to direct sunlight. It has been said that it
is so greedy for sunlight that it eventually kills supporting trees.

Historically ayahuasca is made of
an infusion of the stalk of B. caapi with the leaves
of other plants such as P.viridis or D.cabrerana. B. caapi’s main
contribution to the mixture are the B-carbolines
mentioned previously, while P. viridis and D.cabrerana contribute large quantities of N,N dimethyltryptamine (DMT).
Because various plants are often added to the mixture, the chemical composition
of the brew tends to vary depending on the alkaloid content of the plant used
along with the extraction technique.

Although an ayahuasca brew
contains four main alkaloids, it is DMT which is the primary source of the
hallucinatory/entheogenic experience. DMT is a potent
short-acting hallucinogen that is present in various species of plants found in
temperate and tropical regions. In 1994, Strassman
& Qualls conducted studies investigating the dose-response relationship of
DMT in humans. They intravenously administered 0.04 mg/kg of DMT per 0.4 mg/kg
of body weight and found that the onset of action occurred within two minutes
and was negligible after thirty minutes. The effects of DMT were elevated blood
pressure, heart rate and temperature, dilation of pupils and increased body
endorphin and hormone levels. The psychedelic threshold dose was 0.2 mg/kg body
weight. Hallucinogenic effects included: a rapidly moving, brightly colored
visual display of images. Auditory effects were less common. “Loss of control,”
associated with a brief, but overwhelming “rush,” led to a dissociated state,
where euphoria alternated or coexisted with anxiety. These effects completely
replaced subjects’ previously ongoing mental experience and were more vivid and
compelling than dreams or waking awareness.
When administered orally DMT provokes no psychoactive effects whatsoever,
even in doses as high as one gram. DMT appears to be destroyed in the intestines
by monoamine oxidase (MAO), preventing it from reaching systemic circulation
and the brain. Like LSD, DMT interacts equally with serotonin 5HT1A and 5HT
2a/2c receptors.
Ayahuasca is interesting because it combines DMT,
which is inactive when taken orally, with beta-carbolines.
These tricyclic compounds have proserotonergic
and prodopaminergic properties but lack
hallucinogenic activity. However, beta-carbolines are
potent inhibitors of the MAO enzyme. This MAO inhibiting activity prevents the
oxidative deamination of DMT allowing it to exercise
its effects on the central nervous system.
The experience that follows ingestion of ayahuasca
differs form the effects of parenterally administered
DMT by being less intense but longer lasting. The onset of effect is no longer
instantaneous but occurs approximately one hour after ingestion and lasts 3-4
hours. Adverse effects such as nausea and vomiting occur frequently which are
not observed in the parenteral administration of DMT.
These adverse effects can be attributed to the action of the beta-carbolines.

6.Zanthoxylum schinifolium ^38-43

This drug is the mature peel of the bush or dungarunga Zanthoxylum bungeanum
Maxim. or Z. schinifolium Sieb. et Zucc. of family Rutaceae,produced in most
areas of China,but the best one is produced in Sichuan. The herb is collected
in autumn when the fruit is ature, dried in the sun,cleared of seeds and impurities,and
used unprepared or stirbaked. It is also called Chuanjiao or Shu and prefers
a good deep well-drained moisture retentive soil in full sun or semi-shade.
Flowers are formed on the old wood. Dioecious. Male and female plants must
be grown if seed is required. Self-sown seedlings have occasionally been observed
growing in bare soil in the shade of the parent plant.

The
pericarp is anaesthetic,
diuretic, parasiticide and vasodilator. It is used in
the treatment of gastralgia and dyspepsia due to cold
with vomiting, diarrhoea, abdominal pain, ascariasis
and dermal diseases. It has a local anaesthetic
action and is parasiticide against the pork tapeworm
(Taenia solium). The pericarp contains geraniol. In
small doses this has a mild diuretic action, though large doses will inhibit
the excretion of urine. There is a persistent increase in peristalsis at low
concentration, but inhibition at high concentration. The resin contained in the
bark, and especially in that of the roots, is powerfully stimulant and tonic.

A
methanol extract of the plant showed potent inhibitory activity against
monoamine oxidase (MAO) in a mouse brain.
Activity-guided separation and purification of the extract yielded lacinartin as an active coumarin
compound. Lacitarin showed significant inhibitory
effects on MAO in adose dependant manner. An enzyme
kinetic study revealed that lacitarin inhibited MAO
activity by a non-competitive mode and thus could help in Parkinson’s disease.

7.Ergot ^44-49

The ergot alkaloids have a high biological activity and a broad spectrum
of pharmacological effects, hence they are of considerable importance to medicine.
They have adrenoblocking, antiserotonin and dopaminomimetic properties. Ergot
alkaloids have a therapeutic effect on some forms of migraine, post-partum
haemorrhages, mastopathy, and a sedative effect on the central nervous system
.

In general, the effects of all the ergot
alkaloids appear to results from their actions as partial agonists or
antagonists at adrenergic, dopaminergic, and tryptaminergic receptors. The spectrum of effects depends
on the agent, dosage, species, tissue, and experimental or physiological
conditions. However, some of the actions of the ergot alkaloids are not
entirely compatible with this view: (1) while agonistic effects are generally
apparent only at concentrations that are lower than those required to observe
antagonism, this is not always the case (e.g., the action of methysergide on cerebral blood vessels); (2) the effects of
full agonists (e.g., norepinephrine) are usually
augmented by low concentrations of ergot alkaloids, even those with weak
efficacy as partial agonists (e.g., the action ergonovine
on arterioles); and (3) the contractile responses to other agents, such as
acetylcholine  or angiotensin, are sometimes
also augmented by adrenergic or tryptaminergic
blocking agents. These and other observations emphasize the importance of the
physiological or pathophysiological state in
determining the spectrum and intensity of effects produced in animals or
patients.

Apart from the stereochemical considerations mentioned above, few rules
governing structure-activity relationships have emerged. In general, small
amide derivatives of lysergic acid are potent and relatively selective antagonists
of 5-HT, while the amino acid alkaloids are usually less selective and show
similar affinities as blocking agents at -adrenergic and tryptaminergic
receptors. Dihydrogenated derivatives usually have fewer and less intense
agonistic actions than do parent alkaloids. Finally, insertion of a methyl
group at position 1 usually results in compounds with less affinity for receptors
for catecholamines and with more selective ability to block tryptaminergic
receptors.

All of the natural
alkaloids of ergot significantly increase the motor activity of the uterus.
After small doses contractions are increased in force or frequency, or both,
but are followed by a normal degree of relaxation. As the dose is increased,
contractions become more forceful and prolonged, resting tonus is markedly
increased, and sustained contracture can result. Although this characteristic
precludes their use for induction or facilitation of labour, it is quite
compatible with their use postpartum or after abortion to control bleeding and
maintain uterine contraction. The gravid uterus is very sensitive, and small
doses of ergot alkaloids can be given immediately postpartum to obtain a marked
uterine response, usually without significant side effects.

Ergot Derivatives and Parkinson’s Disease:

Recent studies involving
ergot derivatives in the treatment of Parkinson’s disease have investigated
their effects on dopamine receptors. Most dopamine agonists employed at present
are ergot derivatives. The similarity of the ergoline
ring structure to the endogenous monoamines explains the action of these
compounds on dopaminergic, serotonergic
and adrenergic receptors. Bromocriptine, lisuride and pergolide are the
three oral ergot dopamine agonists presently available. Bromocriptine,
which has potent D₂ agonist properties and a weak D₁
receptor antagonistic effect, was the first ergoline
to be successfully used in Parkinson’s disease. The synthetic ergoline derivative pergolide is
a long acting agonist at D₂ dopamine receptors and has a mild D₁
receptor agonistic effect. Both bromocriptine and pergolide are effective in relieving the symptoms of Parkinson’s
disease and can achieve a reduction of on-off fluctuations. Comparative studies
of both drugs have shown that they have similar efficacy and adverse effects.
The efficacy of a long acting, slow release formulation of bromocriptine
has been shown to be equivalent to standard treatment with bromocriptine,
but patients needed fewer doses daily and had fewer adverse effects. Another
ergot derivative, lisuride, stimulates postsynaptic striatal D₂ receptors and is a mild D₁
receptor agonist. The antiparkinsonian efficacy of
this drug is equivalent to that of bromocriptine and pergolide. Lisuride is highly
water-soluble and can therefore be used for parenteral
therapy via ambulatory infusion pumps. This compound has been shown to be very
effective in controlling motor fluctuations in Parkinson’s disease when
administered by continuous infusion. However, long-term studies of lisuride have shown that its parenteral
use is complicated by a high incidence of psychiatric adverse effects, possibly
because of its serotonergic properties.

Conclusion

The plants, which have been considered, show promising role in acting as
anti Parkinson agents. The use of these drugs in formulating a multi component
herbal formulation along with some multivitamin combinations would surely
help in treatment of this disorder. A detailed and planned research in this
area would prove to be a new thrust in line of treatment of parkinson’s.

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About Authors

Karmarkar S.W., Kannur D. M.*, Parakh S.R.

Maeers Maharashtra Institute of Pharmacy, MIT Campus, Paud Road,
Kothrud, Pune-41103

Ms. Karmarkar S.W 

Final Year B. Pharm Student

Mr. Kannur D. M.^*

Corresponding Author :

Lecturer, Department of Pharmacognosy & Phytochemistry,

Maeers Maharashtra Institute of Pharmacy, MIT Campus, Paud Road, Kothrud,
Pune-411038, Tel : 020-25431795/381, E-mail : dmkannur@rediffmail.com

Dr. Parakh S.R.

Principal & Professor in Pharmaceutics, Maeers Maharashtra
Institute of Pharmacy, Pune-411038