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What's Hot in PD? Update on the Use of Mucuna Pruriens for the Treatment of Parkinson’s Disease

Mucuna pruriens variant utilis (MP) has long been used as an alternative to over-the-counter levodopa. MP is a leguminous plant that grows in both tropical and subtropical environments. Hidden in its seed is levodopa, which is the most important medication for a person with Parkinson’s disease. In this month’s What’s Hot we will review the studies supporting MP use and discuss future directions and global implications for this therapy.

In 2004, Katzenschlager performed a double blind study of MP. Though the study was small and included only eight Parkinson's disease subjects, it was a well-done, randomized, double-blind, crossover trial. The subjects were administered single doses of 50/200 mg Sinemet, and 15 and 30 grams of MP at several weekly intervals. The authors used the Unified Parkinson's Disease Rating Scale and tapping speed to assess changes. They also recorded dyskinesia and adverse events. The MP group had a faster onset of effect (34.6 v 68.5 minutes; p = 0.021), which was also shown in blood studies of the pharmacodynamics. "On" time was longer in the MP group, and there were no differences in adverse effects or in the development of dyskinesia. The Katzenschlager study used a processed pill form of MP (Katzenschlager, 2004).

This week, a paper by Cilia and colleagues describes another study of single-dose MP, but in their study the formulation was completely natural, not pharmacologically processed. The Cilia study used the powder taken directly from roasted MP seeds. Eighteen Parkinson’s disease patients were tested in 6 conditions, including a placebo condition. The Unified Parkinson’s Disease Rating Scale motor scores were recorded at 90 and 180 minutes. The authors  also measured the onset and duration of action. The UPDRS scores that showed motor improvement were similar in the MP and levodopa groups. Both preparations were better than the placebo condition. There were less dyskinesia and adverse events in the MP groups. The higher dose MP had a better "on" response and a longer duration of action (Cilia, 2017).

These studies support the idea that MP is a safe alternative to over-the-counter levodopa. There may be some benefits including a faster onset, longer life, and fewer adverse events, but the results of these studies should be interpreted with caution. There were very few patients in both studies, and the findings may not be representative of the wide spectrum of people with Parkinson’s disease. Additionally, the management of Parkinson’s disease is complicated and dynamic. Frequent changes and adjustments to medication usually underpin successful management. Using an over-the-counter pill form or a natural powder form could prove challenging to adjust and to manage even for the most experienced practitioner. If you are interested in MP, we recommend that it be managed by a neurologist with expertise in Parkinson’s disease. A larger and longer-duration study could unlock the secrets to MP use and could make levodopa available in regions of the world without proper access to Parkinson’s medications.

Selected References

Katzenschlager R, Evans A, Manson A, et al. Mucuna pruriens in Parkinson’s disease: a double blind clinical and pharmacological study. J Neurol Neurosurg Psychiatry 2004;75:1672-77.

Cilia R, Laguna J, Cassani E, Cereda E, Pozzi NG, Isaias IU, Contin M,
Barichella M, Pezzoli G. Mucuna pruriens in Parkinson disease: A double-blind,randomized, controlled, crossover study. Neurology. 2017 Jul 5. pii:10.1212/WNL.0000000000004175. doi: 10.1212/WNL.0000000000004175. [Epub ahead of print] PubMed PMID: 28679598.

Okun MS. Use of Mucuna Pruriens Powder Instead of Levodopa. NEJM Journal Watch Neurology, August 2017.

You can find out more about PF's National Medical Director, Dr. Michael S. Okun, by also visiting the Center of Excellence, University of Florida Health Center for Movement Disorders and Neurorestoration. Dr. Okun is also the author of the Amazon #1 Parkinson's Best Seller 10 Secrets to a Happier Life and 10 Breakthrough Therapies for Parkinson's Disease. You can read more from Dr. Okun in the What's Hot in PD? archives.

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