EP 36 - Think Gut: Why Parkinson’s Medication Sometimes Stops Working

🎙️ Parkinson Weekly – Episode 36In Episode 36 of Parkinson Weekly, Prof. Bas Bloem explores one of the most overlooked reasons why oral Parkinson’s medications can become unreliable: the gut.Drawing on his presentation at the European Academy of Neurology (EAN) Congress in Geneva, Prof. Bloem explains why fluctuating symptoms are not always caused by disease progression alone. While predictable “wearing-off” episodes can often be managed by adjusting medication schedules or adding adjunctive therapies, he highlights the importance of recognising delayed ONs, dose failures and unpredictable OFF periods—all of which may point towards impaired gastrointestinal function.The episode examines how Parkinson’s disease affects the digestive tract long before diagnosis in many people, including delayed gastric emptying (gastroparesis), constipation and small intestinal bacterial overgrowth (SIBO). Prof. Bloem discusses how these conditions can prevent levodopa from reaching the small intestine for absorption or even cause the medication to be broken down before it reaches the brain, leading to inconsistent symptom control.He also reviews practical management strategies, including treating constipation, understanding the current evidence surrounding SIBO, and recognising when it may be appropriate to bypass the gut altogether using device-aided therapies such as deep brain stimulation, continuous infusion therapies, or emerging on-demand treatments like inhaled levodopa.This practical and clinically focused episode provides valuable insights into recognising gastrointestinal causes of motor fluctuations and highlights how addressing the gut can help restore more reliable symptom control, improve mobility, and ultimately enhance quality of life for people living with Parkinson’s disease.Tune in now to discover why, when Parkinson’s medications stop working as expected, the answer may lie in the gut rather than the brain.Have a question you’d like Bas to answer in a future episode? Email us at [email protected] – we’d love to hear from you.