Long-term treatment with high-dose thiamine in Parkinson disease: an open-label pilot study.
Dr. Alan Gaby, MD
Author: Costantini A, et al
Reference: Long-term treatment with high-dose thiamine in Parkinson disease: an open-label pilot study. J Altern Complement Med 2015;21:740-747.
Design: Open-label trial.
Participants: Fifty patients (mean age, 70.4 years) with Parkinson’s disease, with a mean disease duration of 7.3 years.
Study Medication and Dosage: Thiamine, 100 mg intramuscularly, twice a week for 3 months to 2.3 years.
Primary Outcome Measures: Changes in neurological symptoms and fatigue.
Key Findings: The mean score on the Unified Parkinson’s Disease Rating Scale (parts I-IV) improved significantly by 53% within 3 months and remained stable thereafter. The mean motor score (Unified Parkinson’s Disease Rating Scale part III) improved significantly by 55%. Some patients with milder disease had complete clinical recovery. The mean Fatigue Severity Scale score in 6 patients who had fatigue at baseline improved significantly by 55%.
Practice Implications: It is encouraging when a safe and inexpensive treatment is reported to produce substantial benefit in patients with a difficult-to-treat condition such as Parkinson’s disease. However, the results should be interpreted with caution, since the study did not include a control group. Thiamine has been available for many decades, and it has been used in large doses (both orally and parenterally) to treat a wide range of conditions, including some neurological disorders. If thiamine is indeed an effective treatment for Parkinson’s disease, it would be surprising that no one has previously observed this effect. Although placebo-controlled trials are needed to confirm the present report, a therapeutic trial of thiamine would be reasonable for patients with Parkinson’s disease. Clinicians who try this treatment are encouraged to report their findings.