We all know that Parkinson's affects us in more ways than just through movement difficulties. These non-motor problems, such as constipation, probably represent about half the "cost" of Parkinson's to me.

It turns out that the enteric nervous system which controls the gut has dopaminergic neurones which are affected by Parkinson's in a similar way to those in the substantia nigra, the normal focus of interest. It may even be the case that Parkinson's starts in the gut before working up to the brain (the Braak hypothesis).

Given the impact of the non-motor symptoms and the relative ease and safety of working on the gut rather than the brain, I'm surprised that there is not more work being done in the neurogastroenterological area.

Can dopamine itself be taken to treat ENS deficiencies?

Is there an ENS equivalent of DBS?

Are potentially good treatments for non-motor symptoms being missed by the use of overall scores in trials?

There is a good paper by Lebouvier et al on

"Colonic Biopsies to Assess the Neuropathology of Parkinson's Disease and Its Relationship with Symptoms"

which can be found at

http://www.plosone.org/article/info%...l.pone.0012728

John