A number of theories as to what causes PD at the cellular level include oxidative stress and free radical formation, mitochondrial impairment, intracellular protein clumping, inflammation, apoptosis (programmed cell death), and excitotoxicity (5). Many of the prescribed supplements, minerals, and vitamins by alternative practitioners are based upon these theories and the belief or hope that cellular function will be restored and/or future brain cell injury prevented with their use. Currently, there is little if any scientific study to support the use of most of these supplements in the treatment of PD and it is critical to acknowledge that their use specifically for the treatment of PD is based upon theory only and not upon evidence-based clinical research. Despite the lack of research supporting their use for PD, some of these, in particular, the antioxidants that control potentially damaging free radicals or support mitochondrial function may hold the greatest promise for finding a neuropro-tective agent. Some naturally occurring free radical scavengers that exist in the human body at lower levels of activity in PD are superoxide dismutase, glutathione, and coenzyme Q10 (CoQ10). It seems reasonable, therefore, to consider future scientific study of agents that would either promote the production or prevent the degradation of these endogenous antioxidants. In the meantime, the spread of these theories into the public and alternative health field has led to an enormous rise in the use of many supplements, vitamins, and nutrients thought to support basic cellular brain function. Again, their prescribed use is based upon theory and most of the reports supporting their use in PD are anecdotal or at best based upon small, open-label studies (5). The more commonly used agents include those that may increase glutathione levels and promote antioxidant activity such as alpha-lipoic acid, glutathione (orally or intravenous), nicotinamide adenine dinucleotide hydrogen (NADH), and CoQ10 (ubiquinone). Other promoters of cellular function often prescribed by alternative practitioners include acetyl-l-carnitine, selenium, vitamin C, vitamin E, phosphatidyl serine, lecithin, choline, omega-3 fatty acids (fish oil), and flavonoids found in grape seed and pine bark extract called proanthocyanidins. There are few studies to support the use of any of these for the treatment of PD with the possible exception of CoQ10. One small multcenter, randomized, double-blind, placebo-controlled study treated 80 de novo PD patients with either oral CoQ10 (300, 600, or 1200 mg/day) or a placebo for 16 months (10). At 16 months, the 1200 mg/day CoQ10 group scored 44% better in motor function according to the Unified Parkinson's Disease Rating Scale (UPDRS) than the placebo group. Further studies of CoQ10 are warranted.
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