**2.3 Other drugs and their effects**

Gargantuan improvement has been done to treat the PD for over half-century. Diverse individuals from different places have come up with different treatments. Miscellaneous categories of drugs are being used apart from levodopa. Yet to date there are no complete cure strategies for PD. But some symptomatic palliative treatments are being implemented to slow down the disease progression. There are various enzymes used in the management of PD. Enzymes monoamine oxidase-B (MAO-B) and catechol-o-methyl-transferase (COMT) are normally involved in metabolism of dopamine. Therefore, few inhibitors of the two enzymes (MAO-B and COMT) have been extensively studied. Inhibitors like selegiline, rasagiline, tolcapone, and entacapone are being used for the disease modification in PD from previous few years. N-propargyl-methamphetamine is known as selegiline, which is an irreversible inhibitor of MAO-B. Action of selegiline was studied in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induced Parkinsonism in monkeys [67]. It was used at concentration of 10 mg/ day, but they found that it loses its selectivity at higher concentrations of dosage [67]. Various other reports show the neuroprotective potential of selegiline but there is no such report proving that selegiline has "disease-modification" effects [68–70]. The *in vitro* and *in vivo* experimental Parkinsonian models indicate that rasagiline (N-propargyl-1-(R)-aminoindan) acted as irreversible MAOB inhibitor exhibiting anti-apoptotic effect [68–70].

There are various studies proving that the dopamine agonist or levodopa has stronger symptomatic benefits as the MAOB inhibitor; however, there was no evidence of direct comparison between them [71–74]. Older people provide more rapid onset improvement than younger patients. Dopamine agonist is more prominent in younger people with dyskinesia and older people with orthostatic hypotension and CNS effects (hallucinations). Pharmacokinetic studies revel that COMT inhibitors

prevent degradation of peripheral levodopa by extending half-life and also permit it to cross the blood–brain barrier in higher concentrations. There are large number of compounds used to treat motor symptoms and motor complications occurring due to dopaminergic mode of action as reported in review by Oertel et al. Whereas **carbidopa (**modified form of L-dopa soluble**), opicapone (**COMT-inhibitor**), safinamide (**MAO-B-inhibitor**), droxidopa (**NMDA-receptor antagonist**), stradefylline (**noradrenaline precursor**), tozadenant (**Adenosine 2A receptor antagonist**), pimavanserin (**5HT2A inverse agonist**), and donepezil (**Acetyl choline esterase inhibitor**)** are some of the most common compounds used in the treatment internationally [16]. Along with benzhexol and orphenadrine, anticholinergic drugs are also recommended as they reduce the effect of acetylcholine in the brain by antagonizing cholinergic receptors and restore the acetylcholine/dopamine balance within the brain. They also prevent hyperkinesia.

## **3. Neurosurgical treatments**

Apart from chemical drugs, there are some physical therapies involved in the treatment of PD that have given special attenuation toward movement (motor) symptoms of patient. In this treatment, parts of the brain involved in the progression of disease are either removed, bombard with electric impulse, or subjected to neuroimaging [75]. In **pallidotomy and thalamotomy,** the globus pallidus part of the brain, which is overactive in the PD patients, resulting in slackening down the body movements, is surgically destroyed permanently. This destruction of globus pallidus significantly reduces tremor, bradykinesia, balance problems, and writing problems, and eliminates rigidity, while thalamus part is involved in the involuntary movement (like tremor) [76, 77]. **Deep brain stimulation** (DBS) is also one of the unconventional treatments used, in which brain pace markers (microelectrode) are applied where an electrical impulse passes over the electrodes to the specific part of the brain. DBS decreases the secondary difficulties elevated due to dopaminergic replacement therapy. There are survival disadvantages of pallidotomy and thalamotomy cases due to dysphagia, hypophonia, and dysarthria [78]. DBS is having significant results over thalamotomy because it does not need hardware and have very fewer side effects and relatively lowers the risk of complications. Besides all these pharmacological and surgical treatments, few other strategies like speech therapy, mediations are being currently explored along with it for the treatment of PD. Apart from singular therapy, doctors are now recommending a combination of treatments to impart cumulative effect in the treatment of PD.

## **4. Conclusion**

*Mucuna* is a natural, rich source of precursor of dopamine that acts as gold standard for the treatment of Parkinson's disease to control body movements, hormonal balance, emotion, and memory. The *Mucuna* is a pharmaceutically and biochemically valuable plant used from the early days, having high market value due to its large amount of bioactive compounds. It also contains a maximum amount of phenolics, flavonoids, and antioxidants, which have a cumulative role in the release of oxidative stress produced by body systems. *Drosophila melanogaster*, zebrafish, mice/rat, and human models were used to check the potential of *Mucuna* seed powder on rotenone, MPTP-induced Parkinson's model, and it was concluded that *Mucuna* seeds have great values in the treatment of PD. The book chapter also covers various other drugs and neurosurgical treatments used in Parkinson's

**143**

**Author details**

Suresh S. Suryawanshi1

Kolhapur, Maharashtra, India

Kolhapur, Maharashtra, India

Kolhapur, Maharashtra, India

and Jyoti P. Jadhav1,3\*

, Prajakta P. Kamble2

1 Department of Biochemistry, Shivaji University, Vidyanagar,

2 Department of Microbiology, Shivaji University, Vidyanagar,

3 Department of Biotechnology, Shivaji University, Vidyanagar,

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*Address all correspondence to: biochemjpj@gmail.com

provided the original work is properly cited.

, Vishwas A. Bapat<sup>3</sup>

*Parkinsonism and Potential of Mucuna Beans DOI: http://dx.doi.org/10.5772/intechopen.92855*

pruriens) species.

disease. It also gives an introduction to various other species (apart from *Mucuna FSTA*) used in the PD treatment and lowers the burden on commonly used(Mucuna *Parkinsonism and Potential of Mucuna Beans DOI: http://dx.doi.org/10.5772/intechopen.92855*

*Bioethics in Medicine and Society*

within the brain. They also prevent hyperkinesia.

treatments to impart cumulative effect in the treatment of PD.

*Mucuna* is a natural, rich source of precursor of dopamine that acts as gold standard for the treatment of Parkinson's disease to control body movements, hormonal balance, emotion, and memory. The *Mucuna* is a pharmaceutically and biochemically valuable plant used from the early days, having high market value due to its large amount of bioactive compounds. It also contains a maximum amount of phenolics, flavonoids, and antioxidants, which have a cumulative role in the release of oxidative stress produced by body systems. *Drosophila melanogaster*, zebrafish, mice/rat, and human models were used to check the potential of *Mucuna* seed powder on rotenone, MPTP-induced Parkinson's model, and it was concluded that *Mucuna* seeds have great values in the treatment of PD. The book chapter also covers various other drugs and neurosurgical treatments used in Parkinson's

**3. Neurosurgical treatments**

prevent degradation of peripheral levodopa by extending half-life and also permit it to cross the blood–brain barrier in higher concentrations. There are large number of compounds used to treat motor symptoms and motor complications occurring due to dopaminergic mode of action as reported in review by Oertel et al. Whereas **carbidopa (**modified form of L-dopa soluble**), opicapone (**COMT-inhibitor**), safinamide (**MAO-B-inhibitor**), droxidopa (**NMDA-receptor antagonist**), stradefylline (**noradrenaline precursor**), tozadenant (**Adenosine 2A receptor antagonist**), pimavanserin (**5HT2A inverse agonist**), and donepezil (**Acetyl choline esterase inhibitor**)** are some of the most common compounds used in the treatment internationally [16]. Along with benzhexol and orphenadrine, anticholinergic drugs are also recommended as they reduce the effect of acetylcholine in the brain by antagonizing cholinergic receptors and restore the acetylcholine/dopamine balance

Apart from chemical drugs, there are some physical therapies involved in the treatment of PD that have given special attenuation toward movement (motor) symptoms of patient. In this treatment, parts of the brain involved in the progression of disease are either removed, bombard with electric impulse, or subjected to neuroimaging [75]. In **pallidotomy and thalamotomy,** the globus pallidus part of the brain, which is overactive in the PD patients, resulting in slackening down the body movements, is surgically destroyed permanently. This destruction of globus pallidus significantly reduces tremor, bradykinesia, balance problems, and writing problems, and eliminates rigidity, while thalamus part is involved in the involuntary movement (like tremor) [76, 77]. **Deep brain stimulation** (DBS) is also one of the unconventional treatments used, in which brain pace markers (microelectrode) are applied where an electrical impulse passes over the electrodes to the specific part of the brain. DBS decreases the secondary difficulties elevated due to dopaminergic replacement therapy. There are survival disadvantages of pallidotomy and thalamotomy cases due to dysphagia, hypophonia, and dysarthria [78]. DBS is having significant results over thalamotomy because it does not need hardware and have very fewer side effects and relatively lowers the risk of complications. Besides all these pharmacological and surgical treatments, few other strategies like speech therapy, mediations are being currently explored along with it for the treatment of PD. Apart from singular therapy, doctors are now recommending a combination of

**142**

**4. Conclusion**

disease. It also gives an introduction to various other species (apart from *Mucuna FSTA*) used in the PD treatment and lowers the burden on commonly used(Mucuna pruriens) species.
