Baizabal-Carvallo José Fidel, Alonso-Juarez Marlene, Fekete Robert
Department of Sciences and Engineering, University of Guanajuato, León, Mexico.
Department of Medicine, National Polytechnic Institute, México City, Mexico.
Front Neurol. 2021 Sep 10;12:729961. doi: 10.3389/fneur.2021.729961. eCollection 2021.
Parkinson's disease is neurodegenerative disorder with an initial robust response to levodopa. As the disease progresses, patients frequently develop dyskinesia and motor fluctuations, which are sometimes resistant to pharmacological therapy. In recent years, abnormalities in gut microbiota have been identified in these patients with a possible role in motor manifestations. Dysbiosis may reduce levodopa absorption leading to delayed "On" or "no-On" states. Among 84 consecutive patients with PD, we selected 14 with levodopa-induced dyskinesia and motor fluctuations with a Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part IV ≥ 8 points following a trial of pharmacological adjustment 2-3 months prior to study enrollment or adjustments in deep brain stimulation therapy. Patients received treatment with sodium phosphate enema followed by oral rifaximin and polyethylene glycol for 7 and 10 days, respectively. Evaluations between 14 to 21 days after starting treatment showed improvement in MDS-UPDRS-IV ( = 0.001), including duration ( = 0.001) and severity of dyskinesia ( = 0.003); duration of medication "Off"-state ( = 0.004); functional impact of motor fluctuations ( = 0.047) and complexity of motor fluctuations ( = 0.031); no statistical improvement was observed in "Off" dystonia ( = 0.109) and total motor scores ( = 0.430). Marked to moderate improvement in dyskinesia was observed in 57% of cases with blinded evaluation of videos. About 80% of patients perceived moderate to robust improvement at follow-up. A therapeutic strategy aimed at decontamination of intestines showed benefit in motor fluctuations and dyskinesia. Further studies should confirm and clarify the mechanism of improvement observed in these patients.
帕金森病是一种神经退行性疾病，最初对左旋多巴有强烈反应。随着疾病进展，患者常出现运动障碍和运动波动，有时对药物治疗有抵抗性。近年来，已在这些患者中发现肠道微生物群异常，其可能在运动表现中起作用。生态失调可能会减少左旋多巴的吸收，导致“开”或“不开”状态延迟。在84例连续的帕金森病患者中，我们选择了14例有左旋多巴诱导的运动障碍和运动波动的患者，这些患者在研究入组前2-3个月进行药物调整试验或深部脑刺激治疗调整后，运动障碍协会统一帕金森病评定量表（MDS-UPDRS）第四部分≥8分。患者分别接受磷酸钠灌肠治疗，随后口服利福昔明和聚乙二醇7天和10天。开始治疗后14至21天的评估显示MDS-UPDRS-IV有改善（P = 0.001），包括运动障碍的持续时间（P = 0.001）和严重程度（P = 0.003）；药物“关”状态的持续时间（P = 0.004）；运动波动的功能影响（P = 0.047）和运动波动的复杂性（P = 0.031）；“关”期肌张力障碍（P = 0.109）和总运动评分（P = 0.430）未观察到统计学上的改善。在57%的病例中，通过视频盲法评估观察到运动障碍有显著至中度改善。约80%的患者在随访时感觉有中度至明显改善。一种旨在肠道去污的治疗策略对运动波动和运动障碍有益。进一步的研究应证实并阐明在这些患者中观察到的改善机制。
