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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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  • Website URL
    http://movementdisorders.ufhealth.org

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

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  1. Dr. Okun

    Sinemet and Vitamin B6 use

    I actually just recommend any reasonable multivitamin and I personally do not obsess too much about what the exact contents are....until we have more evidence it is hard to know what to recommend but a single multivitamin a day is a good idea.
  2. Dr. Okun

    Elena Sanchez

    Thanks for the comment!
  3. Dr. Okun

    Alternatives To Sinemet

    Sinemet is the best and another alternative may be a Duopa pump where you can control the levels. Rytary is another dopamine formulation and some people also use mucuna.
  4. Dr. Okun

    sq pump

    We have not heard an update for approval but if we hear anything we will post.
  5. Dr. Okun

    First treatment?

    Happy to help.
  6. Dr. Okun

    Gpi and levodopa

    Generally the best is to have the whole situation evaluated starting with lead locations, programming and then medications and therapy. Also the disease progression issues...walking, talking and thinking are not addressed by DBS and will need other strategies. I am really sorry you are struggling....
  7. Here are some answers: 1. I know everyone is different, but how long does the honeymoon period last - 5 years, 10 years? It is different in many patients but can last from months to many years.... 2. Is progression considered to be when symptoms move to the other side of the body. I ask that because my left index finger has a tremor already and all of my other symptoms are on the right side of my body. -- This is one potential indication of depression but progression can be many different symptoms but is often very slow... 3. the Rytary has definitely decreased, by a 1/3 to 1/2, the amount of daily medicine I take for arthritis, spinal disc and joint pains and stiffness. Does that mean those issues that I thought were related to spine and joint problems, were really PD? --Yes, the pain may be PD related, but often there is arthritis in PD patients and you may need both treatments.
  8. Dr. Okun

    First treatment?

    Some people cannot tolerate the Sifrol because of headache and sleep issues and you may want to talk to your doc about not using this strategy.
  9. Dr. Okun

    deep brain stimulator battery replacement

    As long as you realize that when you change the battery you have to rest to the lower levels as it could lead to severe pulling or side effects (after the battery change).
  10. Dr. Okun

    deep brain stimulator battery replacement

    It is not common to increase voltage as the battery runs out.....it is possible but you have to be careful after replacement to set the parameters back to the lower level. Rather than do this we like to replace the battery before symptoms recur. Hope that helps.
  11. Dr. Okun

    Wrong connections - is it possible?

    It is possible to reverse the channels when plugging on the device. As long as you and your doc figure it out the safest thing is to just be aware of it....and they can be switched at the next battery change.
  12. Here are some of things you may consider. 1- a motorized chair does not mean you need to be in the chair at all times 2- make the decision to prevent falling and to enhance quality of life 3- are you socially isolated or at risk of depression and losing important aspects of your life. I discuss these things with my patients and make a decision together.
  13. Dr. Okun

    deep brain stimulator battery replacement

    This is a really important question. I will paste a paper we wrote about this and you can share the data with insurance companies. It is best to have a plan and monitor closely DBS batteries. If settings are high they may run out faster than expected. In some cases we preventatively replace the battery a month or two early and maybe even before ERI light....to prevent symptoms....hope that helps. PLoS One. 2013;8(3):e58665. doi: 10.1371/journal.pone.0058665. Epub 2013 Mar 11. Management of deep brain stimulator battery failure: battery estimators, charge density, and importance of clinical symptoms. Fakhar K1, Hastings E, Butson CR, Foote KD, Zeilman P, Okun MS. Author information Abstract OBJECTIVE: We aimed in this investigation to study deep brain stimulation (DBS) battery drain with special attention directed toward patient symptoms prior to and following battery replacement. BACKGROUND: Previously our group developed web-based calculators and smart phone applications to estimate DBS battery life (http://mdc.mbi.ufl.edu/surgery/dbs-battery-estimator). METHODS: A cohort of 320 patients undergoing DBS battery replacement from 2002-2012 were included in an IRB approved study. Statistical analysis was performed using SPSS 20.0 (IBM, Armonk, NY). RESULTS: The mean charge density for treatment of Parkinson's disease was 7.2 µC/cm(2)/phase (SD = 3.82), for dystonia was 17.5 µC/cm(2)/phase (SD = 8.53), for essential tremor was 8.3 µC/cm(2)/phase (SD = 4.85), and for OCD was 18.0 µC/cm(2)/phase (SD = 4.35). There was a significant relationship between charge density and battery life (r = -.59, p<.001), as well as total power and battery life (r = -.64, p<.001). The UF estimator (r = .67, p<.001) and the Medtronic helpline (r = .74, p<.001) predictions of battery life were significantly positively associated with actual battery life. Battery status indicators on Soletra and Kinetra were poor predictors of battery life. In 38 cases, the symptoms improved following a battery change, suggesting that the neurostimulator was likely responsible for symptom worsening. For these cases, both the UF estimator and the Medtronic helpline were significantly correlated with battery life (r = .65 and r = .70, respectively, both p<.001). CONCLUSIONS: Battery estimations, charge density, total power and clinical symptoms were important factors. The observation of clinical worsening that was rescued following neurostimulator replacement reinforces the notion that changes in clinical symptoms can be associated with battery drain. PMID: 23536810 PMCID: PMC3594176 DOI: 10.1371/journal.pone.0058665 [Indexed for MEDLINE] Free PMC Article
  14. Dr. Okun

    Vitamin B3

    There are a lot of advertisements for Vitamin replacement and Parkinson as well as other degenerative diseases. I have checked and there is no major study on B3 or NAD replacement that has the data to suggest this as a wide scale approach in Parkinson. However, we do recommend one multivitamin a day and these usually have B3.
  15. Dr. Okun

    Neg DatScan and DRD

    You should be able to get the DAT scan disk from the imaging center and bring to another neurologist for interpretation.
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