Botulinum toxin type A for the treatment of gastroparesis in Parkinson’s disease patients

Gil, Ramon; Hwynn, Nelson; Fabian, Thomas; Joseph, Sovi; Fernández, Hubert H.

doi:10.1016/j.parkreldis.2011.01.007

Cited by 32 publications

(12 citation statements)

References 9 publications

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“…There is currently insufficient evidence to support the routine use of intrapyloric botulinum toxin injections for gastroparesis, although a case report of its use in 2 patients with PD was favorable in the short term . Implantation of gastric electrical stimulators has had some favorable reports, although complication rates are not insignificant and long‐term outcome data is lacking.…”

Section: Treatment Of Delayed Gastric Emptying In Pdmentioning

confidence: 99%

Delayed gastric emptying in Parkinson's disease

2013

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Gastrointestinal symptoms are evident in all stages of Parkinson's disease (PD). Most of the gastrointestinal abnormalities associated with PD are attributable to impaired motility. At the level of the stomach, this results in delayed gastric emptying. The etiology of delayed gastric emptying in PD is probably multifactorial but is at least partly related to Lewy pathology in the enteric nervous system and discrete brainstem nuclei. Delayed gastric emptying occurs in both early and advanced PD but is underdetected in routine clinical practice. Recognition of delayed gastric emptying is important because it can cause an array of upper gastrointestinal symptoms, but additionally it has important implications for the absorption and action of levodopa. Delayed gastric emptying contributes significantly to response fluctuations seen in people on long-term l-dopa therapy. Neurohormonal aspects of the brain-gut axis are pertinent to discussions regarding the pathophysiology of delayed gastric emptying in PD and are also hypothesized to contribute to the pathogenesis of PD itself. Ghrelin is a gastric-derived hormone with potential as a therapeutic agent for delayed gastric emptying and also as a novel neuroprotective agent in PD. Recent findings relating to ghrelin in the context of PD and gastric emptying are considered. This article highlights the pathological abnormalities that may account for delayed gastric emptying in PD. It also considers the wider relevance of abnormal gastric pathology to our current understanding of the etiology of PD.

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Section: Treatment Of Delayed Gastric Emptying In Pdmentioning

confidence: 99%

Delayed gastric emptying in Parkinson's disease

2013

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“…In our study, for example, patients with PD with gastroparesis were treated with prokinetics, such as domperidone, or pyloric sphincter BoTox injections, those with small bowel transit delay were treated with prokinetics, while many patients with overlapping abnormalities were treated with combined modalities (data not shown). 29 The colonic data on this cohort have also been previously published. 30 Such therapies, however, were not formally assessed as part of our study given its retrospective nature and the lack of standardisation of the end points for each therapy.…”

Section: Discussionmentioning

confidence: 99%

Utility of the wireless motility capsule and lactulose breath testing in the evaluation of patients with Parkinson's disease who present with functional gastrointestinal symptoms

Gandhy

Barlow

et al. 2017

BMJ Open Gastroenterol

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BackgroundThe aetiology and origin of gastrointestinal symptoms in Parkinson's disease (PD) remains poorly understood. Gastroparesis, small bowel transit delay and bacterial overgrowth may, individually or collectively, play a role.AimsIn patients with PD and functional gastrointestinal symptoms, we aimed to determine the utility of the wireless motility capsule and lactulose breath tests in further defining their symptoms' aetiology.MethodsIn this retrospective cohort study, consecutive patients with PD and functional gastrointestinal symptoms underwent clinical assessment, as well as wireless motility capsule and lactulose breath testing using standard protocols.ResultsWe studied 65 patients with PD and various gastrointestinal symptoms. 35% exhibited gastroparesis by the wireless motility capsule study, 20% small bowel transit delay, while 8% had combined transit abnormalities, suggestive of overlapping gastric and small bowel dysmotility. Small bowel bacterial overgrowth was seen in 34% of cases. Symptoms of abdominal pain, regurgitation, bloating, nausea, vomiting, belching and weight loss could not distinguish between patients with or without gastroparesis, although bloating was significantly more prominent (p<0.001) overall and specifically more so in patients with slow small bowel transit (p<0.01). There was no relationship between delayed small bowel transit time and bacterial overgrowth (p=0.5); PD scores and duration were not correlated with either the transit findings or small bowel bacterial overgrowth.ConclusionsFunctional gastrointestinal symptoms in patients with PD may reflect gastroparesis, small bowel transit delay or both, suggesting motor and/or autonomic dysfunction, and may be associated with small bowel bacterial overgrowth. The wireless motility capsule and lactulose breath testing are non-invasive and useful in the assessment of these patients.

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“…78 Botulinum toxin injections into the pyloric sphincter have been successfully and safely employed to improve gastric emptying in patients with PD, but further testing and confirmation is needed. 79 The ghrelin receptor agonist, relamorelin, has been reported to be effective in relieving gastroparesis in patients with diabetes, but has not been tested in patients with PD. 80 An array of additional pharmacological and nonpharmacological treatment approaches are on the horizon for the treatment of gastroparesis and may eventually be utilized in the setting of PD.…”

Section: Gastroparesismentioning

confidence: 99%

Management of Autonomic Dysfunction in Parkinson's Disease

Pfeiffer

2017

Semin Neurol

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Autonomic dysfunction is a frequent and important nonmotor feature of Parkinson's disease (PD). Autonomic dysfunction in PD spans a broad clinical spectrum. Cardiovascular dysfunction is characterized most prominently by orthostatic hypotension. Gastrointestinal dysfunction can involve virtually all levels of the gastrointestinal tract. Urinary dysfunction can entail either too frequent voiding or difficulty voiding. Sexual dysfunction is frequent and frustrating for both the patient and the partner. Alterations in sweating and body temperature are not widely recognized, but often are present. The presence of effective treatment for at least some aspects of autonomic dysfunction makes it vitally important that the assessment of autonomic dysfunction be a regular component of the neurologic history and examination for individuals with PD.

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Botulinum toxin type A for the treatment of gastroparesis in Parkinson’s disease patients

Cited by 32 publications

References 9 publications

Delayed gastric emptying in Parkinson's disease

Delayed gastric emptying in Parkinson's disease

Utility of the wireless motility capsule and lactulose breath testing in the evaluation of patients with Parkinson's disease who present with functional gastrointestinal symptoms

Management of Autonomic Dysfunction in Parkinson's Disease

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