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February 02, 2021; 96 (5) Article

Probiotics for Constipation in Parkinson Disease

A Randomized Placebo-Controlled Study

Ai Huey Tan, Shen-Yang Lim, Kah Kian Chong, Mohammad Addin Azhan A Manap, Jia Wei Hor, Jia Lun Lim, Soon Chai Low, Chun Wie Chong, Sanjiv Mahadeva, Anthony E. Lang
First published October 12, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010998
Ai Huey Tan
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Shen-Yang Lim
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Kah Kian Chong
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Mohammad Addin Azhan A Manap
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Jia Wei Hor
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Jia Lun Lim
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Soon Chai Low
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Chun Wie Chong
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Sanjiv Mahadeva
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Anthony E. Lang
From the Division of Neurology (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders (A.H.T., S.-Y.L., K.K.C., M.A.A.A.M., J.W.H., J.L.L., S.C.L.), Faculty of Medicine, University of Malaya, Kuala Lumpur; School of Pharmacy (C.W.C.), Monash University Malaysia, Selangor; Division of Gastroenterology (S.M.), Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, Toronto, Canada
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Citation
Probiotics for Constipation in Parkinson Disease
A Randomized Placebo-Controlled Study
Ai Huey Tan, Shen-Yang Lim, Kah Kian Chong, Mohammad Addin Azhan A Manap, Jia Wei Hor, Jia Lun Lim, Soon Chai Low, Chun Wie Chong, Sanjiv Mahadeva, Anthony E. Lang
Neurology Feb 2021, 96 (5) e772-e782; DOI: 10.1212/WNL.0000000000010998

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Abstract

Objective To determine whether probiotics are effective for constipation, a common and often difficult-to-treat problem, in Parkinson disease (PD).

Methods In this double-blind, randomized, placebo-controlled, single-center trial, 280 patients with PD were screened, and 72 eligible patients were block-randomized (1:1) to receive either multistrain probiotics capsules (n = 34) or identical-appearing placebo (n = 38), for 4 weeks. The primary endpoint was the change in the average number of spontaneous bowel movements (SBM) per week during the last 2 weeks of intervention compared with the 2-week preintervention phase, recorded by daily stool diary. Secondary outcome measures included changes in stool consistency, constipation severity score, and quality of life related to constipation. Satisfaction with intervention received was assessed. Change in levels of fecal calprotectin, a marker of intestinal inflammation, was an exploratory outcome.

Results SBM increased by 1.0 ± 1.2 per week after treatment with probiotics and decreased by 0.3 ± 1.0 per week in the placebo group (mean difference 1.3, 95% confidence interval 0.8–1.8, p < 0.001). Significant improvements were also seen for secondary outcomes after correction for multiple comparisons, including stool consistency (p = 0.009) and quality of life related to constipation (p = 0.001). In the treatment group, 65.6% reported satisfaction with the intervention vs only 21.6% in the placebo group (p < 0.001). One patient (2.9%) in the treatment group withdrew due to a nonserious adverse event. Fecal calprotectin did not change significantly during the study.

Conclusions Multistrain probiotics treatment was effective for constipation in PD. Further studies are needed to investigate the long-term efficacy and safety of probiotics in PD, as well as their mechanisms of action.

ClinicalTrials.gov Identifier NCT03377322.

Classification of Evidence This study provides Class I evidence that, for people with PD, multistrain probiotics significantly increased the average number of SBM per week.

Glossary

CFU=
colony-forming units;
CI=
confidence interval;
MDS-UPDRS=
International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale;
PD=
Parkinson disease;
RCT=
randomized controlled trial;
SBM=
spontaneous bowel movements;
UMMC=
University of Malaya Medical Centre

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Class of Evidence: NPub.org/coe

  • Received February 25, 2020.
  • Accepted in final form August 12, 2020.
  • © 2020 American Academy of Neurology
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