Matinum

Taking Charge of Your Health


– So as I stated, I’m Dr. Spears. I’m one of the newer additions to the Movement Disorder and
Parkinson’s Disease Team at the university. So I’m gonna talk to
you a little bit today, I’ve been tasked with talking about alternative therapies
in Parkinson’s Disease. What we’re gonna do is we’re gonna cover a couple things. First and foremost, we’re
gonna talk a little bit about, really, the overview of some terms, so we’re all really on the same page with the language we’re
using so we can have this open conversation about it. Next, we’re gonna talk a little bit about some of the pros and cons and specifically, the safety of some of these alternative therapies, because they’re not all perfectly safe. I’m gonna talk a little
bit, and there’s no way I can talk about
every alternative therapy, so we’re gonna hit some of the high points with the alternative
therapies, and do a little bit of show-and-tell, as well, because there’s a lot of very interesting alternative therapies out there. And then lastly, and this
is really a big topic in Parkinson’s disease and in general, is the role of medical marijuana. And just given by the
number of people here, you guys probably ran out of the medical marijuana samples, or? (audience laughs) Yeah, yeah. What kind of chocolates
are those on the table? – [Woman] Is that part of show-and-tell? – We’ll see, we’ll see. One disclaimer I have,
especially when talking about Parkinson’s disease in general, is that every patient with Parkinson’s disease is unique. There may be very well similarities between given patients, but every patient is unique. So that one patient on the internet who responds excessively well to marijuana with his dyskinesias,
that may very well not be the next person. Everybody’s very different
in their responses to medication and their needs overall. And I found, really,
especially on this topic of alternative therapies, that patients are really the best educators. You guys are the ones who bring all these new frontier treatments, these new frontier alternative therapies to the providers. And a lot of this, and what I know, is really based off of the experiences of the patients I’ve seen. So too often, I know that a perspective that many may have with
alternative therapies, and probably tough to read this caption, but it’s really the doctor
saying to the patient, “We’ve exhausted all
conventional measures. “One last desperate option is to put you “on an alternative medicine “that has 96% success rate.” So I know that may very
well be a perspective that a lot of folks have. It’s not what we intend to do, though, and I’ll try to talk a little bit more about that. But talking, or at least laying out the definition of alternative therapies, and plainly put, this is a diverse group of medical therapies,
interventions, treatments, practices, or products
that share in their common exclusion from conventional
Western practices. Really, things that are
alternate to what we do, mainly with pills and other therapies. I think that definition is tricky. And even the word alternative therapies is a tricky definition
because it really implies that these therapies
are really in opposition or to replace the therapies that we have conventionally for Parkinson’s disease. Things like Sinemet, or thinks like the medications we use
for mood and psychosis in Parkinson’s disease. And I really prefer the term, complimentary than alternative medicine. Because these therapies, by all means, most every one I’m talking about today, can be used alongside and together with our conventional therapies for Parkinson’s disease. So I call them complimentary alternative medicine therapies. At large, this group of therapies, complimentary, alternative,
or what have you, really focus on individuality, they focus on the individual. And they also have this
emphasis on wholism, which is really this
logic of not just treating a disease symptom, OK? Not just treating a symptom of the disease but that that symptom of disease pertains to the part and treating the whole. And it’s, I think,
something that’s definitely something I took from this definition and I think we should all strive to treat. Now the thing about alternative therapies is that they’re not routinely taught in medical schools. And so, I remember back, I think it’s probably been about 10 years now since I went through
the earlier coursework in medical school, and I
think there was one day. One day out of the entire four years where alternative
therapies were brought up. And it wasn’t just specific to Parkinson’s disease. It wasn’t specific to neurologic disease. These were alternative therapies across all of medicine. And that’s really about
the extent that we get as MDs and Dos in our
medical school training. The other thing is that
alternative therapies can be costly because
they’re not routinely, they’re not always reimbursed by insurers. So this is something that, by all means, can have an effect on
what we do in prescribing. And then of course, have a negative effect on pocketbooks sometimes. And then this last thing I have here, this last bullet of the three, is meant to be a double negative. In that alternative therapies are not uncommonly utilized. By this, I mean that alternative therapies are pretty common. And we know that in the US alone, patients with Parkinson’s disease about almost 50%. 40% of folks with Parkinson’s disease have tried some form
of alternative therapy for the treatment of the symptoms of Parkinson’s disease. And in Eastern countries,
this number rises to about three in four, 75% of folks have tried some alternative therapy for Parkinson’s disease. We divide these, and plainly, we try to divide these into things like natural products,
mind and body practices, and then alternative systems practices, which is a confusing term. But alternative therapies is really a blanket term for a lot
of different therapies, not just the things we think about with this class of herbal medicines and nutritional supplements, but we’re talking thinks like homeopathy, chiropractic manipulation, acupuncture, naturopathy, massage, music therapy, and exercise therapy. And this is probably
not an exhaustive list of what really in total, makes up these therapies we call
alternative therapies. So some general principles, some general principles, pros and cons. And this is what I’m
just gonna call the rub. This is the rub, in my mind, is that alternative therapies at large are not always well researched. And as physicians prescribing therapies and prescribing medications, we like to see research and evidence. We like to see the science behind the therapies we use. These alternative therapies are not always regulated by the government, namely, the Food and Drug
Administration or the FDA. And so this also plays into how we use medications really, on a frequent basis. And that we like to
know is this medication gonna be effective, first and foremost? Or is this treatment gonna be effective? How often do we have to give it, what dose do we have to give it, and what kind of side effects are we dealing with? And all that evidence, we just don’t have a lot of it. We don’t have a lot of it towards many of these alternative therapies. In this caption here, just says that, it really hits upon
again, that even though a lot of these are natural substances, these are things that are felt to be in the environment. If the good Lord put them on earth, then they can’t hurt me. There are a lot of side
effects that can happen from natural therapies,
and this is a cartoon with a woman who has flowers growing out of her hair after using
the natural eye drops. So to tie into and really talk about more specific therapies, I just wanted to put up this slide. This is from the National Center for Complementary and Integrated Health, which is part of NIH, or the National Institute of Health. And they polled really and did a survey about what type of alternative therapies are used and what are the most common. Really, out there beyond anything else, we know that natural products are the most commonly used
alternative therapies with many others trailing behind. So when we talk about
these natural products, what we’re really talking about are things that are vitamins, minerals, and tinctures at large, and other
herbals to that regard. The key points. The key points of these,
and I’m not gonna talk about too many specifically,
is that, again, the US Food and Drug
Administration, the FDA, does not strictly regulate
herbs and supplements. They just don’t have enough manpower, they don’t have that emphasis to do so. And the other thing is, is that there’s no guarantee, necessarily,
the safety, strength, or purity of many supplements. There’s just no good governing body. We just don’t know what really is in some of the products that are on
the shelves of the store. Which is a little bit disheartening, which is you need to be cautious about. We know that to date, there have been no dietary supplements shown to halt, slow, or alter Parkinson’s disease. None that have been shown to halt, slow Parkinson’s disease. But it’s not for lack of trying, and not for lack of trying. Because there have been
a fair number of trials, some of them very good and very well-conducted trials,
looking at things anywhere from Vitamin E, or Coenzyme Q10, which is a common one that’s out there. Creatine, ginseng,
ginkgo biloba, uric acid, inosine, which is the
other name for uric acid, and St. John’s wort, and that’s just to name a few. These are all trials that have been largely negative, or haven’t shown results to be really beneficial for patients, namely for patients with
Parkinson’s disease. There are many, and
because our trials can’t keep up, our trials can’t keep up with all the alternative therapies. Trials take a long time, they cost a lot of money to run. We’re never gonna be able to trial every alternative therapy, so there aren’t trials for everything. To name a few, know there aren’t trials for things like ginger,
which is in the news, green tea polyphenols, or green tea, and milk thistle. And then, again,
capitalizing on this point at the bottom is that
to date, we just don’t have any positive trials for these alternative therapies. But there are a couple alternative therapy honorable mentions. And some of these are really interesting, and some of them do have some benefit as opposed to some of the herbals and other supplements. One of which is really interesting and it’s this whole
body vibration therapy. And there’s an interesting backstory on whole body vibration therapy, which apparently developed out of, this is old timing docs, we’re talking almost 200 years ago, where they noticed that patients with the shaking palsy, or Parkinson’s disease, who came in on a long journey, on a bumpy back road via horse drawn carriage,
if it was a bumpy ride, that patient looked
better for a short while at the beginning of that visit. And so that, over time, and that interesting notation, kind of really spurred this interest in whole body vibration therapy, which a number of trials
have gone on so far. It looks like there’s a little bit of evidence for it. And it’s actually still
actively being trialed for Parkinson’s disease. I don’t encourage anybody to shake their loved one, or start shaking. (audience laughs) There’s a lot of bumpy
back roads and I think even bumpy front roads
here in Michigan, I hear. That may very well be enough. The other thing that’s out there, and this actually has lot of evidence. And I think it was
trialed really right down the road at Cleveland
Clinic, is the Theracycle. And the Theracycle comes
in, at least the last time I looked, the series
are 100, 200, and 300. And this is a very special stationary bike which utilizes this principle called force rate exercise, forced rate exercise. And so patients will
get on the Theracycle, people get on this Theracycle, which really forces you to go about 30%. That’s the sweet spot. 30% faster than your voluntary rate, so really getting your heart pumping, really getting you moving. Doing that for a period of time, and they found that, at least temporarily after you do this workout
on the Theracycle, you can have improvement in a number of motor symptoms. The speed of movement,
the swing of movement, or reducing stiffness, and even walking a little bit better. But so far, those results
have been temporary. So unless you’re going back and forth to the Theracycle every couple hours, right now, which I don’t recommend, that would be exhausting. But by all means, we’re starting to get some alternative therapies that have some improvement. I think, and I checked, it’s hard to find Theracycles online. You can find them, and new they go for a lot of money. These things are thousands of dollars. I encourage patients to go to a yard sale or a garage sale and
pick up a stationary bike for 10 bucks. It’s a little bit easier
on the pocketbook, as long as they really push themselves. But the Theracycle, by all means, is something that can be helpful. The other alternative
therapy, and this kind of goes into that, really that umbrella of herbal supplements,
or natural substances, is Mucuna pruriens. And this is a derivative of a bean, of a velvet bean, also dubbed at times, the dopa bean or the dopamine bean, it has a lot of different names to it on the shelves. And this is interesting
because Mucuna pruriens actually does, it actually does have one of the main components, one of the main active components that we use in a lot of our medications for
Parkinson’s disease. And that’s replacing
dopamine, or in this case, giving dopamine, in the form of L-DOPA, which your brain utilizes
and can help slowness, stiffness, and tremor. Now the thing is about Mucuna pruriens, is that these beans
contain just a little bit, just a little bit of the L-DOPA and they don’t contain that other part. For those familiar with Sinemet, Sinemet’s the one name for the medication with two names, the carbidopa, levodopa. The levodopa’s essentially
the L-DOPA component. That’s the work horse in that medication. The carbidopa component is important and included with that medication because it helps offset things like stomach upset and nausea and vomiting from the medication. And it helps offset, or help decrease your body breaking down the L-DOPA before it gets to the brain where it can be active. And the Mucuna pruriens doesn’t have a robust component of carbidopa. And so it’s one of these things that if you need to eat, if
you need to eat enough of the Mucuna pruriens,
enough of the velvet bean to get more substantial
benefit, a motor benefit from it, you may very well run into a little bit of GI upset. Probably great in areas where you can’t have access or you don’t have access to medications like Sinemet or these other medications we have for
Parkinson’s disease. And very well could have effect, especially for mild symptoms of Parkinson’s disease. But as the disease becomes more advanced and the symptoms become
a little bit heavier, I think Mucuna pruriens may be a little bit limited. But by all means, is one that I don’t necessarily, I don’t naysay. So one, we’ve talked
about a couple of things. We talked about the whole
body vibration therapy. We talked about the Theracycle. And then the Mucuna pruriens which are all things that do have a little bit of evidence to show that they can help, at least somewhat. One thing that doesn’t
have a lot of evidence, although it has also been
tried, is acupunture. And so acupuncture, it
really is this therapy based off of an imbalance
or flow in energy. And you get poked with a lot of needles which apparently don’t hurt. I’ve never had acupuncture, but it really doesn’t smart too much. But it’s been tested
for Parkinson’s disease and acupuncture is one of the things that hasn’t shown a lot of improvement. But the thing that has probably shown the most improvement, and we know this, both immediate and long-term, is exercise. Exercise. And if I had, and down in Florida I had a prescription pad, and I would write exercise on the prescription pad and hand it to the patient. Here I don’t have a prescription pad, so I just have to point my finger a lot. Exercise is the most effective, it’s the most effective, hands down, alternative therapy we have for Parkinson’s disease. And if I had a pill, if I could put this in a pill, I would, by all means. It’s the most helpful. And the thing about exercise is it doesn’t really matter exactly what you do. You don’t have to be a weight lifter, you don’t have to be a
champion in that regard. You can do boxing, whether it be through Rock Steady or otherwise,
you can do tai chi, has been found effective. And this is one that the female spouses always giggle when I
say, but tango has also been found to be effective. So it’s anything. Any exercise, anything that gets your body moving, anything that gets your heart rate up. Now for 30 minutes at a
time, greater than half of the days of the week,
I usually say four days of the week or more, is hands down, the most effective
alternative therapy we have for Parkinson’s disease. Both immediate and long-term. I’ve had many patients
even stave off starting medications for Parkinson’s disease really just by exercise. So we’re gonna change gears. We’re gonna change gears here and devote the rest of my time to talking about medical marijuana. OK, medical marijuana. The question about medical marijuana is one that comes up to 95%, or just about every Parkinson’s disease specialist hears the question, “Doc, what about medical marijuana?” And even though that
question’s posed often, we already know about one-third, 36% of patients with Parkinson’s, have tried medical marijuana or cannabis at some point, at some
point in their disease. Now I have to put a
disclaimer on here as well, because right now, and
right now, the environment is that marijuana’s still
federally classified as a Schedule I, Schedule I drug, meaning that the federal government doesn’t identify that marijuana has a medical property or medical component, and identifies it really just as a drug of abuse right now. Which really is tricky
because that interferes with our ability to test
it, and then at large, safely prescribe it and for anybody to safely carry it. So as I’m talking about this, I just wanted to give some credit to one of the movement disorder fellows at the University of
Florida, Dr. Jakoviac. He’s not here today, I don’t think, but he provided a lot of these slides and he’s a great doc if you have a chance to see him when
you come to the clinic. But marijuana itself,
and we’re not talking about CBD or anything like that yet, marijuana we know, has
about 60 active compounds. 60 active compounds is a pretty crude drug or alternative therapy,
as it is, just in itself. At large, the things
that make up marijuana are these two compounds. THC, which is that psychoactive component, provides that euphoria, that good feeling. And then CBD, the cannabidiol. Don’t get a lot of euphoria from that one. It can serve even as an antipsychotic, to an extent. It can break down anxiety a little bit. And people also believe
it has anti-inflammatory, and for one specific condition, anti-seizure properties. But marijuana, we’re talking about marijuana itself,
we’re talking about both of those compounds, THC, and CBD. And marijuana, whether
smoked, whether vaporized, whether ingested, whatever mechanism, has a lot of side effects
associated with it, or can have side effects
associated with it. And these are real side effects. I won’t read them all out to you, but the major ones are can alter your sensory perception, it
can cause perceptual distortions and even
hallucinations in some. It impairs memory and attention. It can make people hungry. That one I think is very well known. And it can really change your gross and fine motor skills. It doesn’t necessarily, marijuana doesn’t necessarily make you, especially from a Parkinson’s disease standpoint, be able to use your hands better, be able to work with your hands better. And then chronically, we
know that there can be a dependence on marijuana,
medical marijuana, or marijuana in itself. And it can lead to cognitive impairments. We’re even starting to identify now that it can even promote or essentially cause dementia, pretty significant memory impairments long-term. In addition to lung disease if smoked, and then also increase
of other mood disorders. Now the thing about marijuana is that cannabidiol component,
that CBD component, we actually have. We have receptors throughout the entirety of our body for cannabidiol. And we call these the CB1 and CB2. And we have a lot of
these receptors actually, in different parts of the brain. Including these deeper
structures of the brain, the basal ganglia, are pretty heavy target for Parkinson’s disease. So there’s something here, there’s something here. And we know that we have these receptors, specific cannabidiol
receptors in the brain. And we think, we think
that CBD could potentially modulate, we can modulate the role of those structures, and may even, it’s been speculated, they’d serve as a neuroprotective role. So knowing that there’s some science, knowing that just some science behind it, we ask neurologists, and
these are neurologists who take care of patients with Parkinson’s disease,
“What do you think? “What do you think, or what kind of role “do you think CBD has “or could have for patients?” A lot of them kind of said the things that we’d probably guess. That it might improve,
it might improve things like appetite, pain, nausea, anxiety. And then everything takes a little drop. Things like tremor, stiffness, dyskinesia, those type of things, I think at large, neurologists are a little hesitant, or at least don’t feel that it packs as much of a punch for. And there’ve been studies now, and there’ve been studies even dating back to 2004, been studies of CBD and medical marijuana in Parkinson’s disease. Probably the one that
has the most evidence behind it, is one where they tested for the levodopa-induced dyskinesias. There’s extra movements that you can get with Parkinson’s disease when you’re at a high level of the
dopaminergic medications, the dopamine medications. And based off of that, at least based off of that study and what we have so far, what we say is that these cannaboid agonists and antagonists, CBD oil, CBD in any other form, whether it be levodopa-induced dyskinesias or otherwise, right now, we just don’t think that they have effect. We haven’t found that they have an effect for those symptoms or otherwise. And that really dates back to some of these studies. And why the American Academy of Neurology, our big governing body, at least I think this dates back to 2017 when they reviewed everything. For Parkinson’s disease right now, we can say it’s probably not effective or probably ineffective. But that doesn’t mean
that we throw the baby out with the bath water. Because again, these medications, especially CBD and the
formulations of CBD, haven’t really been effectively tested, rigourously tested, and
all the different types of CBD haven’t been tested in patients with movement disorders
like Parkinson’s disease. And so we have this article that came out not too long ago, with
some very good researchers and big names in the field
of movement disorders and Parkinson’s disease that said there still might be a chance. We still have to do the
research and science to see if there is a role for CBD. And the American Academy of Neurology really backs this. While they don’t support
using or prescribing medical marijuana for
neurological disorders right now, The American
Academy of Neurology and their lobbyists do think that it would be very helpful if we
could get this medication from a federal level snuck over into a Schedule II or above,
so we can start testing this a little more rigourously, so they can really look at this. And so it’s definitely not a stamp of no, never, it’s more of a stamp of no, right now. We need more evidence. And I think this evidence is gonna come because at large, while
it’s federally illegal, and this could very well have changed since I even picked up this slide. A lot of the United States now, state-wide, are green. Meaning that at some capacity, they have some sort of law or legalization of whether it be medical marijuana, or recreational marijuana. So there aren’t many
states left that don’t have some type of law or legalization for marijuana, especially
for medical purposes. Now in Michigan, in addition
to spelling marijuana in a very interesting
way, just as of July 2018, Parkinson’s disease just now made the list of conditions for which you can get medical marijuana registration for. And just as of July 2018. And that joins a pretty big list now of qualifying conditions. So there’s a lot of
things that you can have, many things no one wants,
but a lot of symptoms and diseases you can have that qualify for medical marijuana in
the state of Michigan. Now to access it, because that’s the next question. One, I think movement disorder specialists and neurologists at
large, we don’t have a lot of evidence that it’s
effective for the symptoms of Parkinson’s disease, but it’s legal in the state of Michigan to prescribe it. So how do I get it? Let me try it. Right now, there’s an application process where it’s actually fairly simple, and it’s fairly simple going online and going through the application process. With just getting a couple things, paying a small fee, and a fee as well to the designated caregiver. They’re gonna be the ones primarily to carry medical marijuana. Because they’ll need a registration and a license to carry
it if they’re giving it to you or for you. And then you do need a physician certification form. And this form is pretty
much a check mark box and a signature from a physician saying that you have such and such condition. So this comes back to really this cartoon of as physicians, are we exhausting all the conventional measures and then just leaving the alternative therapies, which has success rate behind. I think right now, as a physician, especially one treating
Parkinson’s disease, which has lot of symptoms that can be very challenging and tough to treat. I hope, and I can speak
for most of our physicians in the movement disorders division here at Michigan, that we want more therapies. We want more therapies,
especially those backed by evidence, especially
those that are legal and we’re allowed to use
to treat the symptoms of Parkinson’s disease so we can help our patients. We just have to do so in a safe and effective manner. So in summary, right now, there are no dietary supplements that are proven to be effective in the treatment of Parkinson’s disease. The Theracycle has proven
short-term benefits in the motor symptoms
of Parkinson’s disease. And exercise, exercise has proven short and long-term benefits
in Parkinson’s disease and is hands down the
best alternative therapy. And marijuana, CBD and
THC, so marijuana itself, has no proof of benefit
in Parkinson’s disease and carries risks for side effects. However, that subcomponent, that CBD, has distinct neurobiological properties which really demand further study for safety and efficacy so we can start to utilize this, if it’s effective. So we can start to utilize this in a safe and effective way. We’re just not there yet. So these last couple slides are really just animations. And I know with Parkinson’s disease, really the phrase, grab
the bull by the horns, depending on what type
of day you’re having, can really be one that’s tough. But whether it be with
conventional therapies prescribed by your doctor, whether it be for motor symptoms of Parkinson’s disease, or non-motor symptoms
of Parkinson’s disease like those in mood and psychosis. Whether it be conventional or alternative therapies, by all means, we want you to really grab the bull by the horns with this condition so
you can take it down. So with that, I want to say thank you and happy to answer any questions. (audience claps)

19 thoughts on “Alternative Therapies in Parkinson’s Disease

  1. #Parkinsons
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  2. Very interesting! For those who are newly diagnosed with Parkinson's, some helpful information is provided in this article: https://www.responsive-homecare.com/home-care-coral-springs-fl-making-care-decisions-early-parents-experience-parkinsons-disease/

  3. Well, I sure am glad in retrospect that I did not invest time in this presentation as it would seem as though our friends at Michigan Medicine are afflicted by the overabundance of caution syndrome as regards this topic.

  4. stopped giving my mom meat and her shaking totally stopped. Why isn't there a parkinson's diet, if they know there is a element of meat intolerance?

  5. Diagnosed 2012
    My regimen:
    The positives: no button difficulties, brush my teeth now w/o needing elect brush, more strength. Getting in and out of bed, turning over is easier. No more constipation. Parkinson's progression stopped. Suppressed all motor and non-motor symptoms…vitamin B1 (as thiamine HCL)

  6. my father 2 years of suffering Parkinson decease 🙁 need spend lots of money 🙁 work hard, .:( massage my own father and drink medecine anti Parkinson levodopa but, after expired u need massage, leg, neck, hand and buy oxygen in order to breathe, eat everyday 🙁 life is hard and my family will be broken if my father die:(>>>>>>> any tips for removing the Parkinson without deep "brain stimulation" in head that will cost millions of dollar i might die paying so i will better let my father die so if no one can help sad life Parkinson never healed the anti Parkinson tablet will expire not permanen healed my father cost alot of money, if no more money what will happen 🙁 sad LIFE THAT'S MY FATHER LIFE IN SUFFERERING IN PARKINSON 2 YEARS ALREADY ..

  7. What a pathetic excuse for test trials are too costly to run – BULLSH*T — medical industries are wealthy with grants and federal funds, insurances' funds, etc. They have not bothered to investigate deeply enough. I found this excerpt recently from a new medical book I bought: As another example, Parkinson's disease is the result of environmental factors acting on genetically susceptible individuals against a background of normal aging. For significantly more Parkinsonian than control subjects (who are partially or totally defective in an enzyme system which causes a metabolic step called 4-hydroxylation of debrisoquine) have earlier onset of disease. There are volumes of data that P.D. has multiple environmental triggers. Whether you're susceptible depends only in part on your genetics. There is tremendous amount of control that you have over your health in spite of genetics. (Barbeau A, et al, Ecogenetics of Parkinson's disease: 4-hydroxylation of debrisoquine, LANCET, Nov 30, 1985, 1213). Various nutrients, phytochemicals & diet can change your genetic expression.

  8. Be sure to read honest and real reviews of Parkinsons Disease Cure on my blog before you buy. Go to gohonestreviews. com/parkinsons-disease-cure-review/ Thanks, Stanleigh.

  9. I will always keep on writing good and posting my testimonies about you on the Internet,I have been diagnosis with Parkinson for 3 yrs I was tested Parkinson positive,I lost hope and I wept all day,i needed to get cured on time so i was introduced by a blogger who also narrated Her story online on how she was cured of Parkinson by a herbal medication which was sent by Dr Ben i am totally free from Parkinson for anyone that may need the cure should contact Dr Ben on

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