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J Clin Invest 122: 19581959, 2012

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Other neurotransmitter systems are responsible for non-motor symptoms that may precede by decades the clinical onset of motor symptoms

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In patients with cirrhosis, glutamine has been shown to be the alternate route of greater action for detoxifying ammonia, and under conditions of stress, can remove up to 80% of NH3.48 Finally, as mentioned above, diet and exercise play an essential role in those patients