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Mucuna pruriens (also known as "the cowhage" or "velvet" bean; and "atmagupta" in India) is a climbing legume endemic in India and in other parts of the tropics including Central and South America. Sanskrit incunabula suggest it has been used by the ancients since 1500 BC for the treatment of medical ailments. Ayurvedic texts describe Kampavata, a nervous malady bearing similarities to Parkinson's syndrome, responding to atmagupta (mucuna), 1 and mucuna seed preparations are in contemporary use for the treatment of Parkinson's disease (PD) in India. 2 Levodopa ( l -dopa) was first isolated from the seeds of M pruriens in 1937 3 and when the value of l -dopa for the treatment of PD became known, scientific interest in plants rich in l -dopa was revived. Three open label studies, 4- 6 which involved between 18 and 60 patients and used mean dosages of 45 g/day of mucuna seed powder extract (contains about 1500 mg l -dopa), reported significant improvements in parkinsonism for 12-20 weeks. One study 5 suggested tolerability might be better with mucuna than with standard l -dopa preparations.
No published randomised, controlled studies have as yet provided evidence of the efficacy of mucuna extracts in the treatment of PD. The aim of our study was to determine in a double blind fashion whether a particular mucuna seed powder formulation was comparable or superior to synthetically manufactured l -dopa with respect to anti-parkinsonian effect, tolerability, and l -dopa pharmacokinetic profile.
METHODS
Patient selection
Patients with idiopathic PD fulfilling the Queen Square Brain Bank criteria 7 with motor fluctuations and disabling peak dose dyskinesias after each morning l -dopa dose and with a well defined short duration (1.5-4 h) l -dopa response were eligible for inclusion. They were also required to have been stable on fixed doses of anti-parkinsonian treatment for a period of at least 1 month prior to starting the study.
Patients were excluded if their current drug regime included slow-release formulations of l -dopa, catechol O -methyltransferase (COMT) inhibitors, selegiline, anticholinergic drugs, or other drugs that could potentially interfere with gastric absorption (for example, antacids and anti-emetics). Patients showing signs of active psychosis or those on antipsychotic treatment, or patients with clinically relevant cognitive impairment, defined as a...