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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

    Startle Reflex

    Thanks for the comment. Occassonally Keppra is helpful or clonazepam but these can be sedating and sometimes have behavioral side effects.
  2. Dr. Okun


    It varies considerably and we do not talk in averages. We start low and go slow on titrations. Dizziness can be seen but is uncommon. Usually a slower titration helps.
  3. Dr. Okun

    Weight loss

    Good luck.
  4. Dr. Okun

    Running out of energy

    We have heard the same story many times.
  5. Dr. Okun

    First treatment?

    These are reasonable therapies.....studies show Azilect does not at 1mg dose interact with Zoloft and SSRI in almost all cases. Most people use Sinemet or Madopar more than twice a day as the half life is short.
  6. Dr. Okun

    Requip/Ropinirole and weight gain

    In a subset of patients it causes weight gain. In some patients it is impulse control and earting but in others we see weight gain without ICD.
  7. Dr. Okun

    Dyskinesia vs Akinesia

    It is not clear at this time but we see akinesia and dyskinenesia in patients without tremor.
  8. Dr. Okun


    This is a tricky question as there is no right answer. If you start with an agonist monitor for impulse control and have a family member observe you and report to the doc. Many people now start with Sinemet or Madopar without issue. Some people prefer Sinemet if over the age of 70 but there are no hard and fast rules. Whatever you choose, monitor the symptoms and adjust slowly.
  9. Dr. Okun

    Madopar vs Madopar HBS

    Its possible it may improve. Also you may add some carbidopa or benserazide. Sometimes going lower and slower on doses also helps to build tolerance.
  10. Dr. Okun

    Me and deep brain stimulation

    These cases are tricky and it depends on a case by case basis. A lot comes down to the symptoms and whether you respond to levodopa and choosing the target. Some of these cases do improve.
  11. This is a great post and illustrates the importance of not cutting back the medications too much after DBS. It also shows how attention to each issue was helpful. THANK YOU!
  12. Dr. Okun


    Usually it takes several weeks and you will need to keep dialing the dose up with your doctor as .25 per dose may be too low. We build up doses slowly and monitor for side effects such as impulse control disorders (shopping, gambling, etc.).
  13. Dr. Okun

    Weight loss

    Thanks for the question. There is a progressive weight loss that occurs in Parkinson's disease and other neurodegenerative conditions. Many studies are looking at the specific causes and reasons but there seems to be many associated factors. This is a free review on weight loss in PD available on Frontiers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040467/
  14. Dr. Okun


    Answers- Is apathy/anxiety/depression triggered by the on/off cycles of carbiodopa levodopa extended release **It is possible with any preparation of levodopa that you could get neuropsychiatric symptoms when wearing off. or is it because a missing chemical in your brain that is due to parkinsons disease that needs to be put in. **Not known but unlikely one chemical. Is there a test to determine if I am missing that chemical in my brain so then I would know that there is a need for my body to put that chemical in. **No. Is there a test to determine which antidepressant medication is more likely to help a person overcome depression/anxiety? **No. In the parkinsons community is it very common and does it have a good success rate with treatment? **Common and usually treatable. Also to complicate the matter I am on a blood thinner and the information that I see clearly states that SSRI and other forms of antidepressants will increase the risks of bleedly. So I wasn't sure if you have heard of any other parkinsonians that are taking both a blood thinner and a antidepressant. **Important to ask your PD doc and internist.