Objective: The primary objective was to find the effect of 12 weeks of probiotic supplementation on MDS UPDRS score in Parkinson’s Disease. The secondary objectives were to see the effect of probiotics on hs CRP, quality of life and constipation.

Background: Braak et al. hypothesised that alpha-synuclein pathology in Parkinson disease might start in the enteric nervous system or the olfactory bulb. Gut dysbiosis in Parkinson’s disease suggests the spread of bacteria to the brain via the gut-brain axis. However, fecal microbiota transplant has not been uniformly successful. There are reports of improvement in MDS UPDRS scores and constipation with probiotics.

Method: This study was a double-blind placebo-controlled randomised 1:1 parallel allocation double-blind study of Parkinson disease patients (stages 2 and 3 on Hohen and Yahr scale) diagnosed by the UK Brain Bank criteria, recruited from the Movement disorder clinic, Government Medical College, Thiruvananthapuram from 5/5/2020 to 5/2/2021. Patients with dementia, depression, taking probiotics, recent antibiotics and PD history were excluded. The intervention arm received probiotic capsules thrice a day for 12 weeks; each capsule contains 2.5 billion CFU of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii. The allocation was triple blinded (patient, physician and assessor). We assessed MDS UPDRS, PDQ 39, hs CRP and Constipation-Rome IV at baseline and 12 weeks. The sample size was 40 in each arm. Students t-test & chi-square statistical tests were done on IBM SPSS v25.

Results: Compared to the placebo, probiotic caused no improvement in the MDS UPDRS Motor scores. There was a reduction in MDS-UPDRS non-motor scores (specifically fatigue and constipation) and reduced CRP. There was no improvement in the PDQ 39 nor serious adverse effects

Conclusion: Probiotic supplementation did not affect MDS UPDRS motor scores, but it showed improvement in Non-motor MDS UPDRS scores, particularly constipation and fatigue. The reduction in hs CRP could result possibly due to a reduction in gut inflammation. No improvement was noticed in the quality of life.
The study’s strength was that it was a double-blinded RCT, with more than 90% adherence. The limitations were that the Gut flora was not studied, and we included only H & Y Stage 2 and 3. In the future, we can redo the study using multi-strain probiotics

References: 1. Rietdijk CD, Perez-Pardo P, Garssen J, van Wezel RJA, Kraneveld AD. Exploring Braak’s Hypothesis of Parkinson’s Disease. Front Neurol 2017 Feb 13 Available from: http://journal.frontiersin.org/article/10.3389/fneur.2017.00037/full 2. Sun M-F, Shen Y-Q. Dysbiosis of gut microbiota and microbial metabolites in Parkinson’s Disease. Ageing Res Rev. 2018 Aug;45:53–61. Xue L-J, Yang X-Z, Tong Q, Shen P, Ma S-J, Wu S-N, et al. Fecal microbiota transplantation therapy for Parkinson’s disease: A preliminary study. Medicine (Baltimore). 2020 Aug 28;99(35):e22035. 3. Tamtaji OR, Taghizadeh M, Daneshvar Kakhaki R, Kouchaki E, Bahmani F, Borzabadi S, et al. Clinical and metabolic response to probiotic administration in people with Parkinson’s disease: A randomized, double-blind, placebo-controlled trial. Clin Nutr 4. Tan AH, Lim S-Y, Chong KK, Azhan A Manap MA, Hor JW, Lim JL, et al. Probiotics for constipation in Parkinson’s disease: A randomized placebo-controlled study. Neurology. 2020 Oct 12;10.1212/WNL.0000000000010998.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-probiotics-on-mds-updrs-in-parkinson-disease-at-12-weeks-a-randomized-double-blind-placebo-controlled-trial/