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Dr. Okun

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Dr. Okun last won the day on March 3

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About Dr. Okun

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    University of Florida
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    Parkinson disease and movement disorders
  1. Dear Dr. Okun

    please I need to take your opinion about "Vinpocetine"?

    I want to try it with my father with PD, what do you think?

    I read a lot about it, there is some links below

    but he is already on 81mg aspirin protective daily

    & they don't recommend it with blood thinner & antiplatelets

    do you think I can give him every other day alternating with aspirin?

    I mean one day aspirin & next day Vinpocetine and so on?

    Thank you so much Sir for your kindness & great help

  2. This is not a classical presentation of Parkinson and I would recommend you see a neurologist with some experience in PD and he/she can help you sort through the symptoms.
  3. My pleasure.
  4. Rytary won't magically fix this issue. The Parkinson and the dopamine replacement will together push the blood pressure down. The trick is to avoid wearing off and find medication intervals that work to avoid fluctuations and sometimes adding night-time doses. In cases where dizziness or orthostasis or passing out becomes an issue then consider adding hydration, compression stockings, and sometimes medications to increase blood pressure.
  5. We find in these cases it useful to get videos of the actual events throughout the medication cycle and to sort out tremor vs. dyskinesia. Also, there is a form of dyskinesia which occurs as the medications are kicking in and also as wearing off (biphasic) opposed to the common peak dose dyskinesia. Tremor would for example require possibly more medicine and dyskinesia less medications (and sometimes closer intervals or adding agonists). Dyskinesia can also be addressed with amantadine. Finally, DBS is excellent for both med refractory tremor and also dyskinesia.
  6. My pleasure.
  7. Mucuna is a form of dopamine and some of my patients use it. There is one study in JNNP many years ago suggesting some benefits in dyskinesia but in my practice I have not seen any advantage over Sinemet or Madopar. In fact over time many of my patients switch back to Sinemet and Madopar because the absorption and pharmacodynamics (blood levels) are too erratic for the formulation which is over the counter and not regulated. Hope that helps. Azilect can be given at 0.5mg to answer the second question, but studies suggest the 1mg dose to be superior.
  8. So far we have not heard about any issue of Azilect and Mucuna. I will post and see if others have heard of an issue. Azilect and meperidine and certain anaesthetics should not be mixed.
  9. After 5 years 50% of patients develop motor fluctuation and dyskinesia on Sinemet. Not everyone gets dyskinesia but most people at least get wearing off between dosages. This is not a reason to delay treatment as these issues are inevitable. The trick is adjusting dose and medication intervals appropriately.
  10. Agree, I would not try to go every other day! Hope that helps.
  11. Definitely see a neurologist....also in many cases a very low dose of Sinemet was used and simply increasing the dose captures the tremor.
  12. There are cases when patients need to have meds reduced (too many total meds) and sometimes even doses reduced. When this is the case it needs to be done under strict supervision soas not to make people worse.
  13. My pleasure.
  14. I do not believe a decompression machine is appropriate to treat numbness and neuropathy. In typical garden variety Parkinson the motor symptoms will appear eventually on both side may be so mild that you need a carefully examination to uncover the symptoms...
  15. Tough question, but usually no...except when the other condition is affecting similar symptoms as PD.....very tough to disentangle...