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Dr. Okun

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Dr. Okun last won the day on March 26

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About Dr. Okun

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    Advanced Member

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  • Location
    University of Florida
  • Interests
    Parkinson disease and movement disorders

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  1. Dr. Okun

    sq pump

    It's tricky and often trial and error to improve the symptoms you describe. It may be that the wearing off is the underlying cause of the shortness of breath. We usually switch in our clinic to every 2 hours of immediate release sinemet and if we can't find a good dose we consider Duopa pump, DBS, or sometimes cannabinoids. Apo shots can help with off's; but the shortness of breath may be the off and not the apo. There is a new apo pump in trial (recent article). Maybe the pump would help?
  2. Dr. Okun

    Effect of sudden stopping of Sinemet

    It takes us about 5-10 minutes to do the motor portion of the UPDRS examination.
  3. Dr. Okun

    Sinemet /Sinemet plus /Amantadine

    Some people use amantadine 100mg three times a day or extended release especially for dyskinesia. You can also try a lower dose given as the liquid elixer. If it is not effective or giving side effects in our practice we usually stop it.
  4. Dr. Okun

    sq pump

    This is just published in the Lancet Neurology and this month's What's Hot Column addresses this topic. It is an option if available for people with off time and on-off fluctuations. Apomorphine SQ under the skin pump. http://www.parkinson.org/blog/whats-hot/Choosing-Between-Subcutaneous-Apomorphine-Infusions-Intestinal-Pumps-Duopa-and-Deep-Brain-Stimulation-TOLEDO-Trial
  5. Dr. Okun

    Levodopa induced dyskinesia

    I have personally not seen this happen and haven't seen it reported. If anyone has a reference maybe they can share.
  6. Dr. Okun

    Changing from mirapex to Artane

    I use Sinemet in this scenario in my practice. I try not to use artane because of cognitive side effects.
  7. Dr. Okun

    Sinemet /Sinemet plus /Amantadine

    Can you send a specific question. I like amantadine for dyskinesia suppression.
  8. Dr. Okun

    sq pump

    The Duopa pump has a dopamine intestinal gel which is a gel form of dopamine replacement....
  9. Dr. Okun

    non tremor dominant

    Non-tremor dominant Parkinson patients can also have DBS. They need to have the full multidisciplinary evaluation. The recent studies just show that those with tremors may do a little better on average following DBS. Hope that helps.
  10. Dr. Okun

    dbs candidate

    900 mg a day and 300 per dose is considered a good trial for tremor. I always get a gastric emptying study to make sure meds are absorbing. I also confirm the diagnosis of Parkinson by exam and on/off UPDRS testing. Hope that helps. Tremor may be resistant to dopamine.
  11. Dr. Okun


    Generally we don't split the pill unless side effects at the higher doses. If no urinary infection or other cause and the symptoms continue to be worse we generally go up again on the dose by 12.5-25mg at bedtime. You may ask the doc about that option.
  12. Dr. Okun

    Sinemet /Sinemet plus /Amantadine

    Generally the trick is not the formulation but the dosing (right dose) and the interval (time between doses). Both have to be adjusted versus symptoms and also adjusted to avoid wearing off.
  13. Dr. Okun

    Levodopa induced dyskinesia

    It is hard to know but you need to titrate it to the right dose to see improvement. Purposely underdosing is not usually done by experts. Many people who try to underdose or not dose end up with the same issues from disease progression (fluctuations and dyskinesia).
  14. Dr. Okun

    dbs candidate

    Could be; if you have tried high doses of Sinemet (300mg per dose) then this is possible (DBS could help and often does for tremor).