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

Hi John,
I believe that the duodopa treatment acts on the enteric nervous system, and that is part of why it seems to be proving to be a very good treatment for PD. I guess it could be considered the ENS equivalent of DBS......

More than a few advocates would wish for changes in the way that PD is evaluated, and the systems generally used to 'score' it. So, probably, yes to your question on trials. It may also be one of the reasons that trials fail, such scoring systems may be useful in evaluating where the patient is in terms of his/her progression, but given the slow fluctuating nature of PD could be less effective in tracking how effective the treatment is. Throw into the pot the placebo effect, and things become even less certain...... all very debatable.....

It does not surprise me that the paper you refer to comes from a French team, they are much more relaxed on the continent with colonic stuff, and less prone to the 'yuk' factor. This may explain why duodopa seems to be more available in Europe than in the UK, and why the US is just getting around to making it more available (slow passage through the FDA . It seems to be expensive for what it is though, both to install, and for the running costs of treatment .......

Your other question about whether ldopa can be used for ENS issues is very interesting. There can be abdominal pain in PD that is related to this very problem, but I have not seen much that discusses it, or your question.....
perhaps Braak might go into it .........

Lindy

I'm bumping this up from 3 years ago.

Is anyone receiving neurogastroenterological treatment?

Apart from being an end in itself (I'd give a lot to have my constipation cured), I think there's a chance that improvements to the ENS could spread to the brain. (The Braak hypothesis is that disease spreads from the ENS to the brain.)

John

For what it's worth, I have been quite successful in preventing constipation with a herbal laxative called 'Herb-Lax" manufactured and distributed by the Shaklee Corp. Just Google your local Shaklee distributor. I have used it for the entire 13 years since my Dx. My DW is a distributor.

Regarding the neuro-gastroenterological bit, about three years ago when the above referenced PLOS One paper on finding aggregated alpha synuclein in colon sympathetic neurons appeared, I was already scheduled for a scanning colonoscopy due to abdominal discomfort. The GE's report of my test mentioned that my colon epithelium was pigmented, but that the overall result of my test was normal. I later had an abdominal sonogram which nailed gallstones as the source of my "discomfort". (No cholecystectomy or recurrence of symptoms; yet.)

At that time I wondered if my long-term use of the herbal laxative containing senna as one of its components resulted in the pigmentation of the inside of my colon.
(Lindy, I'm pretty OK with the YUK factor!)
Further, I wonder if my slow motor symptom progression might somehow be related to the long-term use of the senna supplement.?
Robert