Manual Parkinson’s Disease—II: Aging and Neuroendocrine Relationships

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Parkinson's Disease - Causes & Pathophysiology - Part 2

If you would like to redeem your KAB credit, please log in. For eJournal Archive and eJournal Backfiles information please contact service karger. This study examined the hour changes in a number of transmitters in the corpus striatum of young and middle-aged male Wistar rats. The striatal serotonin and dopamine turnover was also measured.

Aging and Neuroendocrine Relationships

Both young and middle-aged rats showed significant hour variations in striatal glutamate and aspartate contents; only in young rats these variations fitted a cosine function, with acrophase during the first part of rest span. Mesor values of striatal excitatory amino acid contents were lowest in middle-aged rats. Significant hour variations in striatal contents of GABA, taurine, and glycine occurred in young rats, while only striatal GABA exhibited hour changes in middle- aged rats acrophases during the first part of rest span.

For every inhibitory transmitter, the mesor values in middle-aged rats were significantly lower than in young rats.


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The hour variation of the striatal somatostatin content showed acrophase during the first part of rest span, mesor values and amplitude being lowest in middle-aged rats. We considered that NMS-Quest with its section dedicated to constipation description would be more appropriate in the evaluation of cases with neurological conditions.

Considering the fact that this study was designed for PD patients who are having minor GI symptoms, we made the decision to use some drugs and nutritional supplements that are already used for symptom management in patients with IBS. In a meta-analysis published in , the significant treatment benefit in favor of prokinetic agents, including trimebutine, in patients with functional dyspepsia was clearly highlighted. Trimebutine is a therapeutic agent prescribed mostly in patients with functional dyspepsia, IBS, chronic constipation, and other functional GI disorders.

This is due to its effect on the regulation of the motility of the digestive system acting on the GI tract via 1 an agonist effect on peripheral mu, kappa, and delta opiate receptors and 2 releasing of GI peptides such as motilin and the modulation of the release of other peptides, including vasoactive intestinal peptide, gastrin, and glucagon.

Trimebutine accelerates gastric emptying, induces premature phase III of the migrating motor complex in the intestine, and modulates the contractile activity of the colon.

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We were also encouraged by our previous data, where we studied some upper GI-NMS in patients with PD and dyspeptic complaints, with promising outcome seen in patients treated with trimebutine. This study showed promising results of prokinetics like trimebutine in the management of some mild-to-moderate lower GI-NMS like constipation, bloating, and abdominal pain. Recent data presented an interesting hypothesis regarding the brain—gut axis that could be modulated by the gut microbiota via immunological, neuroendocrine, and direct neural mechanisms.

At this point, we are aware of the existence of one pilot study using probiotics as a single strain. Our experience with probiotics was very encouraging, as it showed good results in mitigating some GI symptoms like bloating and abdominal pain. It could be possible that association of prokinetics with probiotics is much more beneficial to a certain category of patients. It is hard to anticipate and evaluate if this schedule of treatment would be satisfactory enough in improving more severe lower GI-NMS.

Another aspect that could also be considered as a limitation is the fact that we enrolled only patients with mild-to-moderate severity of the GI-NMS. This experience should be extended to attempt managing more severe lower GI complaints in PD patients, and should ideally be addressed in further discussions and debates.

On the basis of our results, lower GI-NMS are frequently present, alone or associated with other autonomic issues. Thus, many of them were recorded long before the diagnosis of PD. The treatment with trimebutine showed promising results in alleviating all assessed symptoms. However, probiotics also showed good potential in mitigating many abdominal complaints.

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DG contributed to creating the study design, drafting the article, and carrying out the interpretation of the data. II assisted in the proofreading of the manuscript and the reviewing of all the tables and figures. Therefore, all authors contributed in reviewing this manuscript and in carrying out the interpretation of the statistical analysis of the data. In addition, all authors hold rights to the intellectual content of this article. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

CNS Spectr. The impact of comorbid disease and injuries on resource use and expenditures in parkinsonism. Mov Disord. J Neurol Neurosurg Psychiatry. Clin Auton Res.

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Neural control of the gastrointestinal tract: implications for Parkinson disease. Movement Disorder Society task force report on the Hoehn and Yahr staging scale: status and recommendations. Lyons KE, Pahwa R. Am J Manag Care. Gastrointestinal symptoms in Parkinson disease: clinical aspects and management. Can J Neurol Sci. Simuni T, Sethi K. Ann Neurol. Ann Acad Medicare Steninensis. J Neurol.

Autonomic dysfunction in parkinsonian disorders: assessment and pathophysiology. Lancet Neurol.

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Breen KC, Drutyte G. J Neural Transm.


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A randomized placebo-controlled study. Barone JA. Domperidone: a peripherally acting dopamine2-receptor antagonist. Ann Pharmacother. The clinical overlap between functional dyspepsia and irritable bowel syndrome based on Rome III criteria. BMC Gastroenterol. Meta-analysis of the effects of prokinetic agents in patients with functional dyspepsia. J Gastroenterol Hepatol.

The associations between Parkinson’s disease and cancer: the plot thickens

Schmulson M, Chang L. The treatment of functional abdominal bloating and distension. Aliment Pharmacol Ther. Understanding dyspepsia in PD. Eur J Neurol Suppl. Mulak A, Bonaz B. World J Gastroenterol. Minerva Gastroenterol Dietol.