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Dr. Okun

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Dr. Okun last won the day on August 25

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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


    It is variable across patients and different strategies work for different patients. The key is monitoring.
  2. I don't buy into all the formulas as being exact. I follow symptoms. Reasonable to use formula and go slow, but titrate up or down by symptoms as it is just a guess.
  3. Dr. Okun

    Fatigue after DBS battery replacement

    Yes, it is possible after battery surgery to experience fatigue from the surgery, anaesthesia or other factors. If it is linked to the surgery and does not resolve to baseline in a few weeks probably best to alert your doc.
  4. Dr. Okun

    Does your size matter?

    Excessive sleepiness, dyskinesia, high energy level are all symptoms that may emerge in some patients with higher doses of Sinemet.
  5. Dr. Okun


    Everyone is different. If you try lower doses of Sinemet/Madopar and increase agonists you could still have side effects so it would need to be monitored. Everyone is different so it may work in some cases.
  6. Dr. Okun


    You should definitely have a chat with your care team and see what they think.
  7. Dr. Okun

    Question about Link between dopamine and testosterone

    Great question. Our group actually studied this and we could not find a relationship between testosterone level and levodopa (Sinemet) dose.
  8. Dr. Okun

    Does your size matter?

    Great question. Sometimes the dose must be adjusted over time and it is not always higher.....sometimes it is lower. If there are symptoms like dyskinesia for example you and your doc may try lower doses....
  9. Dr. Okun


    It really depends on what your practitioner is comfortable with.....all work and must be titrated and monitored for side effects (ICD's etc.). CR will sometimes peak less in the bloodstream and lead to less sleepiness. Sometimes a lower dose of Rytary can be found....it is trial and error.
  10. Dr. Okun


    Great questions. I generally do not aggressively stop meds after DBS as it can lead to anxiety, depression, apathy and other symptoms....I may try gentle reductions but do it slowly and sometimes restoring meds helps anxiety. As I have read through posts sometimes the solution is to reduce time between l-dopa doses to treat off-time anxiety. 1. How do you and patient decide what is the better option between anti-anxiety meds or reduce time between sinemet doses? -I almost always optimize Parkinson meds first and move doses closer together and find the right dose as in many cases it is simple wearing off. 2. How does anxiety typically progress over the course of Parkinsons disease? Are there progressive treatments? -It is highly variable patient to patient but in broad strokes as you wear off between doses this seems to make anxiety symptoms worse. 3. What is the biological cause of anxiety in PD? Are there treatments based on biology of PD anxiety? -We believe it is a biological change from degeneration of brain regions important to non-motor function. 4. Can certain foods trigger anxiety? Foods to avoid? -Not sure on that one, but if they do I would think a rare cause. Thanks so much for all you do. I love your forums and helpfulness. -Totally happy to help. Also, once I adjust meds and DBS (if you have it) I also consider cannabinoids for anxiety.
  11. Dr. Okun


    My pleasure.
  12. Dr. Okun


    I am sorry this must be frustrating. A DAT scan may set your mind at ease.
  13. Dr. Okun

    Sinemet and Amantadine

    Great question. I do not know of a study examining this question, but in my experience it doesn't make a difference; except that taking before Sinemet may help with dyskinesia in some cases. It also matters if you take immediate release (3 times a day) vs. extended release (once a day).
  14. Dr. Okun

    Endoscope procedure

    My pleasure.
  15. Dr. Okun

    Sinemet & Dyskinesia Question

    Thanks and good luck. Remember that 1 in 5 Parkinson patients get demoralized and it may not be depression. Consider that in some but not all cases counseling with a licensed clinical social worker may be helpful (or psychologist).