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About Bergamotte

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  1. Bergamotte

    How to Rule Out Parkinson's Coexisting with CM?

    Thank you so much, Dr. Okun. Theoretically, in a patient who has both CM and Parkinson's, is it possible that the spinal pathology may limit the amount of symptomatic improvement achievable with anti-Parkinson's medications?
  2. Loving wife and caregiver for husband who is being treated for Parkinson's disease. We have just been told he doesn't have Parkinson's but cervical myelopathy.

  3. Dear Dr. Okun: My 84-year-old husband has been treated for presumed Parkinson’s for the last two years with levodopa/benserazide. He has bradykinesia, rigidity, on-and-off right hand tremor, and increasing weakness in the right arm and right leg. Both legs are increasingly spastic; he’s very bouncy on rising from a chair. He has a poor response to medication (it never helped him much with movement even on 600 mg of levodopa per day). Dose increases simply exacerbate the sleepiness and dizziness, making it harder for him to exercise. Recently I took him to be seen for a second opinion on his medical therapy. An experienced neurologist examined him, he thought he saw hints of spinal pathology in the gait, he didn’t see a parkinsonian gait at all; and he informed us that possibly my husband does not have Parkinson’s. He ordered cervical spine MRI which was consistent with spinal cord compression and compression of a nerve root on the right, with probable cervical myelopathy. Two electrophysiologic tests confirmed the CM diagnosis. The neurologist told us that this pathology accounts for all my husband’s movement-related symptoms. We accept the new diagnosis of cervical myelopathy. We want to discontinue the levodopa (a slow taper would be our preference); but is there a way to confirm first that he does not have Parkinson’s in addition to CM? The second-opinion neurologist felt safe in instructing us to completely stop the levodopa therapy for two days at home “to see what happens”, a sort of stress test; but I am reluctant to do that because I fear the possibility of malignant syndrome. My husband is chronically under-hydrated despite all my efforts to get him to drink. Thank you for your thoughts, Dr. Okun.