PD ExpertBriefing: When Parkinson's Interferes with Gastrointes3nal Func3on

Size: px

Start display at page:

Download "PD ExpertBriefing: When Parkinson's Interferes with Gastrointes3nal Func3on"

Basil Perkins
5 years ago
Views:

PD ExpertBriefing: When Parkinson's Interferes with Gastrointes3nal Func3on Led By: Peter A. LeWi,, M.D., Professor of Neurology, Wayne State University School of Medicine and Director, Parkinson s

1 PD ExpertBriefing: When Parkinson's Interferes with Gastrointes3nal Func3on Led By: Peter A. LeWi,, M.D., Professor of Neurology, Wayne State University School of Medicine and Director, Parkinson s Disease and Movement Disorder Program, Henry Ford Hospital This session was held on: Tuesday, June 24, 2014 at 1:00 PM ET. If you have any quesoons, please contact: Valerie Holt at vholt@pdf.org or call (212)

2 Introduc3on Robin Anthony Ellio, President Parkinson s Disease FoundaOon 2

3 Objec3ves To understand how Parkinson s disease affects the gastrointesonal system To be able to idenofy some common gastrointesonal issues that people with Parkinson s disease may experience, such as difficulty with bowel movements To learn pracocal ways for managing these problems, including medicaoons, diet and addioonal strategies 3

4 Gastrointes3nal Impairment in Parkinson s Disease Recognized as problems by James Parkinson M.D., in his 1817 treaose An Essay on the Shaking Palsy Among the recognized problems of gastrointesonal (GI) funcoon in Parkinson s disease are: Disordered salivaoon (drooling) Swallowing difficulty (dysphagia) Gastric paresis (decreased or slowed emptying funcoon) ConsOpaOon (decreased bowel movement frequency) Defecatory difficulty 4

5 Gastrointes3nal Impairment in Parkinson s Disease Each of these problems has one or more management strategies SomeOmes a team approach is needed with a gastrointesonal (GI) specialist or a speech/ swallow therapist PrevenOng consopaoon is different from treaong consopaoon once it is present Improving gastrointesonal (GI) funcoon can have a posiove impact on the consistency of benefit from Parkinson s disease medicaoons 5

6 Movement Disorders 2011; 26:

7 Movement Disorders 2011; 26:

8 Movement Disorders 2011; 26:

9 Movement Disorders 2011; 26:

10 The Gastrointes3nal System 10

11 Commonly- used Treatments for Cons3pa3on Increased fluid (water) intake Increased fiber content of diet Foods that enhance intesonal transit Non- prescripoon treatments to prevent and treat Milk of magnesia Sorbitol and polyethylene glycol (MiraLax ) Stool soheners (docusate) High- fiber supplements Magnesium citrate (Citroma ) Bisacodyl (Dulcolax ) 11

12 Prescrip3on Drugs That Can Be Used to Treat Cons3pa3on lubiprostone (AMITIZA ) tegaserod (Zelnorm ) linacloode (LINZESS ) 12

13 Recent Findings That Parkinson s Disease May Start in the GI Tract Research is poinong to early (and possibly inioal) findings that the disoncove cellular changes of Parkinson s disease begin not in the brain but, rather, in the colon These findings might provide new insight in how the disease could be diagnosed early and how the brain disorder might evolve 13

14 α- synuclein Staining of Lewy Bodies in Parkinson s Disease Brain SpillanOni MG, et al. Nature 1997; 388:

15 Aggregates of α- synuclein Found in Colon Tissue (BöQner et al, 2012) Staining for α- synuclein in Ossue layers of the colon (a e) and in a brain secoon from a paoent with Lewy body demenoa (f) 15

16 Colon Biopsies Taken Prior to Onset of Parkinsonian Features (Shannon et al, 2012) Healthy control 2-yrs pre-pd 2-yrs pre-pd 3-yrs pre-pd Stained for α-synuclein 16

17 Other Gastrointes3nal MaQers in Parkinson s Disease ConsOpaOon as a prodromal (early) feature Bacterial overgrowth in the small intesone a factor that might interfere with drug absorpoon Helicobacter pylori infecoon and motor fluctuaoons Slowed gastric emptying (and improvement with levodopa treatment) 17

18 MOVE- PD Study for Cons3pa3on A clinical study of a new treatment for chronic consopaoon in PD is ongoing at several sites around the US This brief clinical trial is being conducted by the Parkinson Study Group at approximately 15 clinical sites in North America There is no cost for parocipaoon in this important research (see the Parkinson Study Group website for informaoon study- group.org) 18

19 MOVE- PD Study for Cons3pa3on The drug is relamorelin (RM- 131), a drug sharing the properoes of ghrelin, which is a naturally- occurring small molecule that somulates receptors specific sites in the GI tract Like ghrelin, relamorelin acts to enhance muscle contracoons and propulsion of contents in the GI tract, and it has greater effects than ghrelin 19

20 THANK YOU! Peter A. LeWiQ, M.D. Wayne State University School of Medicine Parkinson s Disease and Movement Disorders Program, Henry Ford Hospital West Bloomﬁeld, Michigan USA

21 Ques3ons and Discussion 21

22 Please complete our SURVEY. Your responses help us to improve the work that we do. Thank you. 22

23 Resources from PDF Fact Sheet GastrointesOnal and Urinary DysfuncOon in Parkinson s PD Resource List 750 Resources Parkinson s HelpLine Available at (800) or info@pdf.org Monday through Friday 9:00 AM 5:00 PM ET 23

24 Upcoming PD ExpertBriefings Occupa3onal Therapy and Parkinson s: Tips for Healthy Living Tuesday, September 9, 2014, 1:00 PM - 2:00 PM ET Faculty: Linda Tickle- Degnen, Ph.D., OTR/L, FAOTA, Professor, Department of OccupaOonal Therapy, Director, Health Quality of Life Lab, School of Arts & Sciences Tuhs University; Sue Berger, Ph.D., OTR/L, BCG, FAOTA, Clinical Associate Professor, OccupaOonal Therapy, Boston University College of Health and RehabilitaOon Sciences: Sargent College Parkinson's and Paren3ng: The Impact of PD on Children and Young Adults Tuesday, November 18, 2014, 1:00 PM - 2:00 PM ET Faculty: Elaine Book, M.S.W., R.S.W., Clinic Social Worker, Pacific Parkinson's Research Centre, University of BriOsh Columbia Hospital 24

25 Please complete our SURVEY. Your responses help us to improve the work that we do. Thank you. 25

PD ExpertBriefing: The Effects of Exercise on PD

PD ExpertBriefing: The Effects of Exercise on PD Led By: Margaret Schenkman, P.T., Ph.D., F.A.P.T.A. Associate Dean for Physical Therapy Education, and Director, Physical Therapy Program, University of