Parkinson's Insights

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 parkinsonweekly@gmail.com – we’d love to hear from you.

EP 35 - “What to do, if even David Marsden would not have a clue”

🎙️ We’re back with Episode 35 of Parkinson Weekly, hosted by Prof. Bas Bloem.Recorded live at the European Academy of Neurology (EAN) Congress in Geneva, this special episode sees Prof. Bas Bloem reflect on his C. David Marsden Award Lecture, entitled “What to do, if even David Marsden would not have a clue”.Prof. Bloem explores how clinicians can approach particularly challenging movement disorder presentations when the diagnosis is far from straightforward. Drawing on the themes of his lecture, he outlines the value of a structured, multistep approach to reaching a clinically based diagnosis, even in the most complex cases.The episode also highlights the importance of developing an eclectic approach to clinical practice. Prof. Bloem discusses the value of identifying your own clinical heroes, learning from the skills and qualities that make them exceptional, and incorporating the best of these into your own clinical repertoire — while combining them with your individual strengths, preferences and abilities.Recorded from EAN 2026 in Geneva, this episode offers a fascinating insight into clinical reasoning, lifelong learning and the art of becoming a better clinician.Tune in now to hear Prof. Bas Bloem share the key lessons from his C. David Marsden Award Lecture.Have a question you’d like Bas to answer in a future episode? Email us at parkinsonweekly@gmail.com – we’d love to hear from you.

Could Tavapadon reshape early Parkinson’s treatment? Could selective dopamine signaling be the next step forward? A dopamine receptor agonist is a medication that stimulates dopamine receptors in the brain to help improve movement. Unlike currently available dopamine agonists that primarily target D2/D3 receptors, Tavapadon selectively targets D1/D5 receptors, an approach designed to preserve motor benefit while potentially reducing some troublesome side effects. Fernandez and colleagues describe in a new paper in The Lancet Neurology evaluating Tavapadon in early Parkinson's disease. Key points: - Tavapadon significantly improved motor symptoms and activities of daily living compared w/ placebo in folks w/ early Parkinson's disease, and benefits emerged as early as 5 weeks. - Tavapadon was generally well tolerated, though nausea, headache and dizziness were more frequent than placebo, and adverse events were most common during dose titration. - Rates of somnolence and impulse control disorders were low, suggesting a potentially differentiated safety profile compared w/ currently available dopamine agonists, though longer follow-up is still needed. My take: We have been waiting for a new dopamine agonist strategy that attempts to separate motor benefit from some of the side effects that have limited the use of older agents. The results are encouraging; however this is not a home run yet. The study lasted only 27 weeks, and we still need long-term data on durability, tolerability, dyskinesias and impulse control disorders. If these findings hold up over time, Tavapadon could become an important new option for treating early Parkinson's disease. Here are 3 points that resonated w/ me: 1- This study reminds us that innovation in Parkinson's disease is not limited to disease modifying therapies. Better symptomatic treatments can meaningfully improve daily life. 2- A once daily medication that improves motor function while maintaining a relatively low rate of sleepiness and impulse control disorders would be welcome news for many folks and their health care providers. 3- The titration period mattered. Many side effects occurred early.

Excited to join Roon’s early community as a Founding Physician. We're building the digital home for medicine - a trusted space where doctors can connect, collaborate, and advance clinical knowledge together. Medicine's richest insights happen in everyday conversations between colleagues, but those discussions are scattered and often lost. Roon changes that. If you’re a U.S.-based physician, please join the community. Coming soon to the international community & other healthcare professions. I also want to share that I have no financial interest in this platform, and I simply believe that it is a great idea to create dialogue in this community. Decades ago in the 1990's I was part of a similar effort called Physicians Online (POL) if anyone is old enough to remember that early posting board. https://x.com/roondoctors https://www.roon.com/doctors/explore