Cannabis and its derivatives for the use of motor symptoms in Parkinson’s disease: a systematic review and meta-analysis

Background: Recent changes to the legal status of cannabis across various countries have renewed interest in exploring its use in Parkinson’s disease (PD). The use of cannabinoids for alleviation of motor symptoms has been extensively explored in pre-clinical studies. Objective: We aim to systematically review and meta-analyze literature on the use of medical cannabis or its derivatives (MC) in PD patients to determine its effect on motor function and its safety profile. Methods: We reviewed and analyzed original, full-text randomized controlled trials (RCTs) and observational studies. Primary outcomes were change in motor function and dyskinesia. Secondary outcomes included adverse events and side effects. All studies were analyzed for risk of bias. Results: Fifteen studies, including six RCTs, were analyzed. Of these, 12/15 (80%) mention concomitant treatment with antiparkinsonian medications, most commonly levodopa. Primary outcomes were most often measured using the Unified Parkinson Disease Rating Scale (UPDRS) among RCTs and patient self-report of symptom improvement was widely used among observational studies. Most of the observational data lacking appropriate controls had effect estimates favoring the intervention. However, the controlled studies demonstrated no significant motor symptom improvement overall. The meta-analysis of three RCTs, including a total of 83 patients, did not demonstrate a statistically significant improvement in UPDRS III score variation (MD −0.21, 95% CI −4.15 to 3.72; p = 0.92) with MC use. Only one study reported statistically significant improvement in dyskinesia ( p < 0.05). The intervention was generally well tolerated. All RCTs had a high risk of bias. Conclusion: Although observational studies establish subjective symptom alleviation and interest in MC among PD patients, there is insufficient evidence to support its integration into clinical practice for motor symptom treatment. This is primarily due to lack of good quality data.

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Effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life for patients with Parkinson’s disease: A systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215521990526 ◽

2021 ◽

pp. 026921552199052

Author(s):

Zonglei Zhou ◽

Ruzhen Zhou ◽

Wen Wei ◽

Rongsheng Luan ◽

Kunpeng Li

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Motor Function ◽

Meta Analysis ◽

Freezing Of Gait ◽

Movement Therapy ◽

Walking Velocity

Objective: To conduct a systematic review evaluating the effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life among individuals with Parkinson’s disease. Data sources: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, and Physiotherapy Evidence Database was carried out to identify eligible papers published up to December 10, 2020. Review methods: Literature selection, data extraction, and methodological quality assessment were independently performed by two investigators. Publication bias was determined by funnel plot and Egger’s regression test. “Trim and fill” analysis was performed to adjust any potential publication bias. Results: Seventeen studies involving 598 participants were included in this meta-analysis. Music-based movement therapy significantly improved motor function (Unified Parkinson’s Disease Rating Scale motor subscale, MD = −5.44, P = 0.002; Timed Up and Go Test, MD = −1.02, P = 0.001), balance (Berg Balance Scale, MD = 2.02, P < 0.001; Mini-Balance Evaluation Systems Test, MD = 2.95, P = 0.001), freezing of gait (MD = −2.35, P = 0.039), walking velocity (MD = 0.18, P < 0.001), and mental health (SMD = −0.38, P = 0.003). However, no significant effects were observed on gait cadence, stride length, and quality of life. Conclusion: The findings of this study show that music-based movement therapy is an effective treatment approach for improving motor function, balance, freezing of gait, walking velocity, and mental health for patients with Parkinson’s disease.

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Weeding through the haze: a survey on cannabis use among people living with Parkinson’s disease in the US

npj Parkinson s Disease ◽

10.1038/s41531-021-00165-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Megan P. Feeney ◽

Danny Bega ◽

Benzi M. Kluger ◽

A. Jon Stoessl ◽

Christiana M. Evers ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Scientific Evidence ◽

Symptom Control ◽

Cannabis Use ◽

Symptom Improvement ◽

Motor Symptoms ◽

The Us ◽

Alternative Means ◽

Non Motor Symptoms

AbstractSymptomatic management of Parkinson’s disease (PD) is complex and many symptoms, especially non-motor symptoms, are not effectively addressed with current medications. In the US, cannabis has become more widely available for medical and recreational use, permitting those in the PD community to try alternative means of symptom control. However, little is known about the attitudes towards, and experiences with, cannabis use among those living with PD. To address this shortcoming, we distributed an anonymous survey to 7,607 people with PD in January 2020 and received 1339 responses (17.6%). 1064 complete responses were available for analysis. Respondents represented 49 states with a mean age of 71.2 years (±8.3) and mean PD duration of 7.4 years (±6.2). About a quarter of respondents (24.5%) reported cannabis use within the previous six months. Age and gender were found to be predictors of cannabis use in this sample (Age OR = 0.95, 95% CI 0.93 to 0.97; Male OR = 1.44, 95% CI 1.03 to 2.03). Users reported learning about cannabis use from the internet/news (30.5%) and friends or other people with PD (26.0%). Cannabis users were more likely to report insufficient control of their non-motor symptoms with prescription medications than non-users (p = 0.03). Cannabis was primarily used for PD (63.6%) and was most often used to treat nonmotor symptoms of anxiety (45.5%), pain (44.0%), and sleep disorders (44.0%). However, nearly a quarter of users (23.0%) also reported they had stopped cannabis use in the previous six months, primarily due to a lack of symptom improvement (35.5%). Three quarters of respondents (75.5%) did not use cannabis, primarily because there was a lack of scientific evidence supporting efficacy (59.9%). Our results suggest that the lack of formal guidance or research evidence about cannabis for PD may in part underlie inconsistencies in both use and reported effectiveness.

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Motor Symptom Asymmetry Predicts Non-motor Outcome and Quality of Life Following STN DBS in Parkinson's Disease

10.21203/rs.3.rs-871480/v1 ◽

2021 ◽

Author(s):

Julie Péron ◽

Philippe Voruz ◽

Jordan Pierce ◽

Kévin Ahrweiller ◽

Claire Haegelen ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Motor Symptom ◽

Control Group ◽

Motor Symptoms ◽

Healthy Control ◽

The Impact ◽

Stn Dbs

Abstract Risk factors for long-term non-motor disorders and quality of life following subthalamic nucleus deep-brain stimulation (STN DBS) have not yet been fully identified. In the present study, we investigated the impact of motor symptom asymmetry in Parkinson’s disease.Data were extracted for 52 patients with Parkinson’s disease (half with left-sided motor symptoms and half with right-sided ones) who underwent bilateral STN and a matched healthy control group. Performances for cognitive tests and neuropsychiatric and quality-of-life questionnaires at 12 months post-DBS were compared with a pre-DBS baseline. Results indicated a deterioration in cognitive performance post-DBS in patients with left-sided motor symptoms. Performances of patients with right-sided motor symptoms were maintained, except for a verbal executive task. These differential effects had an impact on patients’ quality of life. The results highlight the existence of two distinct cognitive profiles of Parkinson’s disease, depending on motor symptom asymmetry. This asymmetry is a potential risk factor for non-motor adverse effects following STN DBS.

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FAKTOR-FAKTOR YANG MEMPENGARUHI SUBTIPE GEJALA MOTORIK PENYAKIT PARKINSON

Human Care Journal ◽

10.32883/hcj.v5i1.649 ◽

2020 ◽

Vol 5 (1) ◽

pp. 343

Author(s):

Attiya Istarini ◽

Yuliarni Syafrita ◽

Restu Susanti

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Age At Onset ◽

Motor Symptom ◽

Disease Stage ◽

Motor Symptoms ◽

Research Subjects ◽

Cross Sectional ◽

Duration Of Disease ◽

Cross Sectional Design

Background: Parkinson's disease (PD) is a chronic neurodegenerative disease that manifests as movement disorders. Based on motor symptoms, PD is classified into subtypes of tremor and postural instability gait disorders (PIGD). The motor symptoms subtype is a predictor of disease progression, therapeutic response, and quality of life for Parkinson's patients. The purpose of this study is to identify some factors that influence motor symptoms in Parkinson's disease.Methods: This research use cross sectional design. Samples were selected by consecutive sampling method that met the inclusion and exclusion criteria. Research subjects were 58 people. Statistical analysis using SPSS. p values <0.05 were considered statistically significant.Results: This research include 58 patients, 55.2% were men with range of age 63.5 ± 8.5 years old. The mean age at onset was 57.9 ± 9.5 years and duration of disease 6.1 ± 4.6 years. Motor symptoms 53.4% dominant tremor. There was a significant relationship between disease stage and motor symptom subtypes (p <0.001). There is no relationship between the patient's age, age at onset and duration of the disease with motor symptom subtypes.Conclusions: There is a relationship between disease stage and motor symptom. The patient's age, age at onset and duration of the disease are not related to the motor symptoms of Parkinson's patients.

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Use Of Antihypertensive Agents And Risk Of Parkinson’s Disease: A Meta-Analysis Of Observational Studies

Value in Health ◽

10.1016/j.jval.2016.03.1719 ◽

2016 ◽

Vol 19 (3) ◽

pp. A100

Author(s):

A Mullapudi ◽

K Gudala ◽

C Boya ◽

D Bansal

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Observational Studies ◽

Meta Analysis ◽

Antihypertensive Agents

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Dual-task training on gait, motor symptoms, and balance in patients with Parkinson’s disease: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215520941142 ◽

2020 ◽

Vol 34 (11) ◽

pp. 1355-1367

Author(s):

Zhenlan Li ◽

Tian Wang ◽

Haoyang Liu ◽

Yan Jiang ◽

Zhen Wang ◽

...

Keyword(s):

Systematic Review ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Meta Analysis ◽

Cochrane Library ◽

Motor Symptoms ◽

Gait Parameters ◽

Task Training ◽

Dual Task Training

Objective: The aim of the present study was to systematically evaluate and quantify the effectiveness of dual-task training on gait parameters, motor symptoms and balance in individuals diagnosed with Parkinson’s disease. Data resources: A systematic review of published literature was conducted until May 2020, using PubMed, EMBASE, Cochrane Library, Web of Science, EBSCO and CNKI databases. Methods: We included randomized controlled trials (RCTs) and non-RCTs to evaluate the effects of dual-task training compared with those of non-intervention or other forms of training. The measurements included gait parameters, motor symptoms and balance parameters. Methodological quality was assessed using the PEDro scale. Outcomes were pooled by calculating between-group mean differences using fixed- or random-effects models based on study heterogeneity. Results: A total of 11 RCTs comprising 322 subjects were included in the present meta-analysis. Results showed that dual-task training significantly improved gait speed (standardized mean difference [SMD], −0.23; 95% confidence interval [CI], −0.38 to −0.08; P = 0.002), cadence (SMD, −0.25; 95% CI, −0.48 to −0.02; P = 0.03), motor symptoms (SMD, 0.56; 95% CI, 0.18 to 0.94; P = 0.004) and balance (SMD, −0.44; 95% CI, −0.84 to −0.05; P = 0.03). However, no significant changes were detected in step length or stride length. Conclusion: Dual-task training was effective in improving gait performance, motor symptoms and balance in patients with Parkinson’s disease relative to other forms of training or non-intervention.

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The Impact of Mind-Body Exercises on Motor Function, Depressive Symptoms, and Quality of Life in Parkinson’s Disease: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010031 ◽

2019 ◽

Vol 17 (1) ◽

pp. 31 ◽

Cited By ~ 6

Author(s):

Xiaohu Jin ◽

Lin Wang ◽

Shijie Liu ◽

Lin Zhu ◽

Paul Dinneen Loprinzi ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Depressive Symptoms ◽

Motor Function ◽

Exercise Intervention ◽

Meta Analysis ◽

Cochrane Library ◽

The Impact

Purpose: To systematically evaluate the effects of mind-body exercises (Tai Chi, Yoga, and Health Qigong) on motor function (UPDRS, Timed-Up-and-Go, Balance), depressive symptoms, and quality of life (QoL) of Parkinson’s patients (PD). Methods: Through computer system search and manual retrieval, PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang Database, and CQVIP were used. Articles were retrieved up to the published date of June 30, 2019. Following the Cochrane Collaboration System Evaluation Manual (version 5.1.0), two researchers independently evaluated the quality and bias risk of each article, including 22 evaluated articles. The Pedro quality score of 6 points or more was found for 86% (19/22) of these studies, of which 21 were randomized controlled trials with a total of 1199 subjects; and the trial intervention time ranged from 4 to 24 weeks. Interventions in the control group included no-intervention controls, placebo, waiting-lists, routine care, and non-sports controls. Meta-analysis was performed on the literature using RevMan 5.3 statistical software, and heterogeneity analysis was performed using Stata 14.0 software. Results: (1) Mind-body exercises significantly improved motor function in PD patients, including UPDRS (SMD = −0.61, p < 0.001), TUG (SMD = −1.47, p < 0.001) and balance function (SMD = 0.79, p < 0.001). (2) Mind-body exercises also had significant effects on depression (SMD = −1.61, p = 0.002) and QoL (SMD = 0.66, p < 0.001). (3) Among the indicators, UPDRS (I2 = 81%) and depression (I2 = 91%) had higher heterogeneity; according to the results of the separate combined effect sizes of TUG (I2 = 29%), Balance (I2 = 16%) and QoL (I2 = 35%), it shows that the heterogeneity is small; (4) After meta-regression analysis of the age limit and other possible confounding factors, further subgroup analysis showed that the reason for the heterogeneity of UPDRS motor function may be related to the sex of PD patients and severity of the disease; the outcome of depression was heterogeneous. The reason for this may be the use of specific drugs in the experiment and the duration of intervention in the trial. Conclusion: (1) Mind-body exercises were found to have significant improvements in motor function, depressive symptoms, and quality of life in patients with Parkinson’s disease, and can be used as an effective method for clinical exercise intervention in PD patients. (2) Future clinical intervention programs for PD patients need to fully consider specific factors such as gender, severity of disease, specific drug use, and intervention cycle to effectively control heterogeneity factors, so that the clinical exercise intervention program for PD patients is objective, scientific, and effective.

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Lee Silverman Voice Treatment (LSVT)-BIG to improve motor function in people with Parkinson’s disease: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215517734385 ◽

2017 ◽

Vol 32 (5) ◽

pp. 607-618 ◽

Cited By ~ 12

Author(s):

Michelle N McDonnell ◽

Briony Rischbieth ◽

Tenille T Schammer ◽

Chantel Seaforth ◽

Alex J Shaw ◽

...

Keyword(s):

Systematic Review ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Confidence Interval ◽

Motor Function ◽

Randomized Trials ◽

Meta Analysis ◽

Mean Difference ◽

Lee Silverman Voice Treatment ◽

Voice Treatment

Objective: The technique called Lee Silverman Voice Treatment (LSVT)-LOUD has previously been used to improve voice quality in people with Parkinson’s disease. The objective of this study was to assess the effectiveness of an alternate intervention, LSVT-BIG (signifying big movements), to improve functional mobility. Design: Systematic review with meta-analysis of randomized trials. Data sources: Medline, Embase, CINAHL, AgeLine, Scopus and Cochrane Library were searched from inception to September 2017 using multiple search terms related to Parkinson’s disease and LSVT-BIG. Review method: Two researchers searched the literature for studies of the LSVT-BIG intervention of 16 sessions, delivered by a certified instructor over four weeks, to any other intervention. Outcomes related to functional ability were included. Study quality was appraised using the Cochrane Risk of Bias tool. Results: Four studies were included, reporting on three randomized trials of 84 participants with mild Parkinson’s disease. Compared to physiotherapy exercises, or a shorter training protocol, there was a significant improvement in motor function assessed with the Unified Parkinson’s Disease Rating Scale part III (mean difference = −3.20, 95% confidence interval = −5.18 to −1.23) and a trend towards faster Timed Up and Go performance (mean difference = −0.47, 95% confidence interval = −0.99 to 0.06) and 10-metre walk test (mean difference = −0.53, 95% confidence interval = −1.07 to 0.01). Conclusion: Compared to shorter format LSVT-BIG or general exercise, LSVT-BIG was more effective at improving motor function. This provides preliminary, moderate quality evidence that amplitude-oriented training is effective in reducing motor impairments for people with mild Parkinson’s disease.

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