End of life Manifest signed in Rome

Interfaith Manifest of Rights in End-of-Life Pathways signed in Rome. This is the work that is the result of a particular sensitivity to interreligious dialogue in health care, in the perspective

Waiting lists

I was told that they are not accepting reservations until the end of December and that they do not yet have availability for the January lists. Is it true that

Narrative medicine (preview)

Nowadays very often physicians identify patients no longer by their actual name, but by the room number in which they reside and perhaps the condition from which they suffer. It

Patient empowerment

“Nothing about me, without me” “Nothing I don’t know, not without me ” This is the phrase that best expresses the concept of patient empowerment in the terms of the

Parkinson’s disease: gut microbiota may interfere with therapy


What does the gut microbiota have to do with a neurodegenerative condition such as Parkinson’s disease? Until yesterday, nothing, it was thought. Today, however, there seems to be a relationship, at least for those taking levodopa drugs to control tremors and muscle rigidity. That is, the vast majority of patients.

The role of gut bacteria

Intensive studies in recent years are teaching us that the gut microbiota serves as virtually everything, acting as an interface between us and the world and regulating countless enzymatic reactions and physiological functions. When healthy, everything is going well; when destabilized or depleted, the risk of seeing various ailments and diseases arise or worsen significantly increases.

In the case of
the situation is somewhat different. Indeed, the characteristics and activity of patients’ gut bacteria do not create problems per se, but may interfere with the effectiveness of levodopa therapy: a dopamine precursor compound that must be constantly supplied from outside to replace dopamine no longer produced by the brain cells in the substantia nigra, degenerated due to the disease.

Levodopa is never administered on its own, but always in conjunction with a second substance called a “decarboxylase inhibitor,” which is essential so that levodopa is not rapidly converted into dopamine by the decarboxylases in the blood, but can reach the brain, where it must exert its action of modulating muscle tone.

It has been known for decades that, from the onset of the disease, different patients require different dosages of levodopa/inhibitors of decarboxylases to keep the symptoms of Parkinson’s disease under control and that, in all cases, the effective dosage gradually increases over time (due to a decrease in drug efficacy). Until now, however, no one could explain the reasons behind these phenomena.

New data on the effectiveness of therapy

A study recently published in Nature Communication suggests why this happens. In essence, the problem seems to be related to the ability of some intestinal bacteria (in particular, lactobacilli and enterococci, in which the constituent intestinal microbiota is rich) to transform levodopa into dopamine at the level of the small intestine, thus making it easily degraded soon after absorption and preventing sufficient amounts from reaching the brain.

Apparently, some Parkinson’s disease patients have a microbiota that is particularly active on this front, due to very high bacterial decarboxylase activity: this would make patients partially “resistant” to levodopa therapy, from which they might derive less than average benefits and gradually decrease over time.

Although it remains to be understood how to exploit these new data at the clinic-practice level, this is important information because it offers the possibility of improving and prolonging the efficacy of levodopa therapy by a different approach than those used so far, namely by modulating the composition of the gut microbiota and/or the activity of bacterial decarboxylases.


Sebastiaan P et al. Gut bacterial tyrosine decarboxylases restrict levels of levodopa in the treatment of Parkinson’s disease. Nature Communications 2019;10:310. doi:10.1038/s41467-019-08294-y



Bipolar disorder

Bipolar disorder is a complex and delicate mood disorder to manage that leads sufferers to experience periods of depressed mood, characterized by symptoms similar to those of major depression, alternating

Neurovegetative dystonia

If you have the patience to interview a family doctor whose outpatient clinic is always very crowded, you will find that a good portion of patients are afflicted with a

Borderline personality disorder

Borderline personality disorder is a psychiatric disorder characterized by a fluctuating perception of one’s value and identity, with sudden swings from a very positive and idealized view of oneself to

Obstructive sleep apnea syndrome

Obstructive sleep apnea is the most prevalent type of sleep apnea: a category of disorders united by the occurrence of repeated interruptions of normal breathing while sleeping, due to a


Epilepsy is a chronic neurological disorder of the central nervous system, characterized by recurrent acute attacks (seizures), unpredictable in frequency, intensity and duration, interspersed with periods of well-being in which

Spinal canal stenosis

Spinal canal stenosis consists of the narrowing of a section of the canal present along the entire spine (formed by the aligned succession of small holes in the center of

Meniere’s Syndrome

Meniere’s syndrome is a balance disorder characterized by recurrent and unpredictable “attacks” involving the onset of intense dizziness, associated with reduced hearing, whistling and buzzing. Each attack is heralded by

Deep brain stimulation

The deep brain stimulation (Deep Brain Stimulation, DBS) is a neurosurgical method involving the implantation in the brain of electrodes which, appropriately positioned and activated by a pulse generator inserted

Sleep and menopause

Sleep disorders are one of the health problems most often reported by women approaching menopause and in the period after (climacteric). The need for sleep naturally tends to decrease with

Parkinson’s disease

Parkinson’s disease is an aging-related neurodegenerative disorder of the central nervous system, affecting about 2.5% of people over 70 years of age, which is mainly characterized by resting tremor in

your advertising
exclusively ON

complete the form and you will be contacted by one of our managers