Journal of the Neurological Sciences 184 (2001) 9192

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Response to the Letter to the Editor

Ayurveda in Parkinsons disease

a a,b b c,
P. Sankarankutty , N. Nagashayana , P.K. Mohan , K.P. Mohanakumar *
a
Department of Kayachikitsa, Govt. Ayurveda College, Thiruvananthapuram 695 001, India
b
Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Ulloor, Thiruvananthapuram 695 011, India
c
Laboratory of Neurochemistry, Division of Pharmacology and Experimental Therapeutics, Indian Institute of Chemical Biology,
4, Raja S.C. Mullick Road, Calcutta 700 032, India

Received 30 November 2000; accepted 30 November 2000

We are delighted that, Dr. Deleu and colleagues [1] look
at our data as interesting and consider the beneficial effect
of palliative and cleansing therapy with Ayurvedic medica-
tion in Parkinsons disease as promising. We do agree with
their dissention that our study design could have provided
for a double blind set-up. We are fully aware of the
possible influence of investigatory bias on the treatment
outcomes in unblinded studies [2]. We now realize that we
have not clearly spelt out our methodology in
Nagashayanas report [3]. It may be stated here that our
report was only a preliminary observation made in a
long-term study program on the benefits and problems of
Ayurveda treatment in Parkinsons disease. In this joint
collaborative study the patients were admitted and treated
in the Ayurveda college hospital under the care of Ayur-
veda doctors (Dr. Nagashayana, Dr. Nampoothiri and Dr.
Sankarankutty, all MD in Ayurveda) specialized in
Kayachikitsa. A visiting neurologist from a different
hospital (Dr. P.K. Mohan, MD) ranked the patients. Since
this was a preliminary investigation we opted for a single
blind study, wherein the visiting neurologist was unaware
of the treatment schedule or the group to which a patient
belongs. Moreover, the patients were also evaluated by
postgraduate students, whose observations agreed with the
neurologists findings. If it is of any concern, the clinical
data was also analyzed by a third person stationed at
Calcutta (Dr. K.P. Mohanakumar, Ph.D.), a place distant
from the place of study, and who was totally blind to the
study protocol. We confirm here that our study was not
*Corresponding author. Tel.: 191-33-473-3491; fax: 191-33-473-
0284.
unblinded, but single blinded, and our unbiased reporting
is evident from our claim that improvement was observed
only in certain parameters, and not in others.
As for the second point raised by Deleu et al. [1] on the
placebo effect, we have given consideration to Geneva
declaration of the world medical association [4]. We may
submit here that the major objective of this pilot study was
to evaluate the effects of Ayurveda therapy on the signs
and symptoms of Parkinsons disease. We have also
compared the effects of combined cleansing and palliative
therapy with that of palliative therapy alone. We have
included more than 20 signs and symptoms of Parkinsons
disease in the evaluation of our patients apart from
UPDRS, stiffness and cramp-like pain of the lower limbs.
To combined cleansing and palliative therapy, more than
60% of the patients showed improvement, which is much
more than 22% improvement reported with placebo
therapy [5] for motor activity. Maybe this is unconvention-
al, but we believe it is significant. Our study is a
preliminary open trial, based on the principles of treatment
in Ayurveda for Parkinsonism. The ingredients of the
herbal combination administered have been in use by
Ayurvedic practitioners (see [6]). However, in the light of
new evidence [5], a placebo run-in phase may be added in
further studies, especially to control the placebo response
in the motor function of the UPDRS section, which is
significantly influenced.
The point raised by Deleu et al. regarding the data in
mental functions of the patients in our studies is un-
warranted. To make it clearer, 72% of the total patients (13
out of 18) had normal mental functions, which simply
means that there were 5 patients with impaired mental
function. Four of them were in the group which received
combined cleansing and palliative therapy and one re-

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ceived only palliative therapy, all these 5 patients showed
varying degrees of improvement in their mental function
within our study.
We are only happy to agree with Deleu and colleagues
that our observations on a small number of patients have to
be confirmed by a larger study before any firm conclusions
can be made regarding the efficacy of Ayurveda therapy in
Parkinsons disease. The long-term studies are under
progress. The need of scientific evaluation of the ancient
Indian medical system as well as complementary therapies
in the Parkinsons disease along with Ayurveda treatment
cannot be over-emphasized [7]. One of the problems that
we face in our long-term study is the drop-out of the
patients. There were dropouts from both groups during the
reported study due to various reasons. Cleansing therapy
was given only to those patients who agreed to undergo
both palliative and cleansing therapy. However the data
shown is from the patients who have completed the study.
It is believed that dropouts did not impinge on the veracity
of the conclusions made.
References
[1] Deleu D, Hanssens Y, Northway MG. Levodopa, Ayurveda and
Parkinsons disease. J Neurol Sci 2001;184:8990.
[2] Chalmers TC, Celano P, Sacks HS, Smith H. Bias in treatment
assignment in controlled clinical trials. N Engl J Med
1983;309:135961.
[3] Nagashayana N, Sankarankutty P, Nampoothri MRV, Mohan PK,
Mohanakumar KP. Association of L-Dopa with recovery following
Ayurveda medication in Parkinsons disease. J Neurol Sci
2000;176:1247.
[4] World Health Organization, Research Guidelines for evaluating the
safety and efficacy of herbal medicines. Annex 1; World Medical
Association Declaration of Helsinki 1993:5964.
[5] Gotez CG, Leugans S, Raman R, Stebbins GT. Objective changes in
motor function during placebo treatment in PD. Neurology
2000;54:7104.
[6] Gouri-Devi M, Ramu MG, Benkatraman BS. Treatment of Parkin-
sons disease in Ayurveda (ancient Indian system of medicine):
Discussion paper. J Royal Soc Med 1991;84:45.
[7] Manyam BV, Sanchez-Ramos JR. Traditional and complementary
therapies in Parkinsons disease. Adv Neurol 1999;80:56574.