soccertese,

Thank you for bringing this to our attention.

My understanding of it is that it is both good and bad news.

The good news. MAO-B inhibitors give some mild symptomatic relief, with 1 mg of rasagiline having approximately the same integrated effect as 100 mg of levodopa, albeit over a very much longer time period (24 hr cf 3-4 hr), so its impact at any one time is limited. There is also debate as to whether MAO-B inhibtors provide neuroprotection. The Azilect study did not prove this. But taking a meta-analysis approach across the range of MAO-B inhibitors, for instance including studies of selegiline, gives some weak evidence of a protective effect. Being able to have the same effect through diet must be a good thing where the expense of the drug treatment is high.

The bad news is twofold. First, there is a natural limit to what can be achieved with MAO-B inhibitors: once you have inhibited MAO-B, which takes approximately 1 mg of rasagiline per day, there is no further benefit. In other words, unlike levodopa based therapies, there is no additive effect. Second some of the herbs and plants mentioned in the paper's abstract, were thought to have theraputic potential for PD. If this benefit were to be limited to their MAO-B inhibition then, as pointed out in the first point, their maximum benefit is limited: their marginal benefit, on top of a person on rasagiline say, is likely to be very low.

John