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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. Not that I am NOT a fan, but my strategy is to add one drug at a time....if the combo works then could consider combo drug. Weaning is usually a slow process over a few weeks and no exact right way to do it.
  2. I am not aware of any benefits. I am also unaware of risks but best to get the label and run by the pharmacist and the doc.
  3. I usually try to simply in these cases to Sinemet only as the agonist could be affecting the fatigue. I also move dosages closer together and search for the optimal dose. You just haven't found the right timing and meds yet....that is my bet. Your doc may be trying to hard to limit doses.
  4. As the disease progresses missing medication dosages can lead to wearing off and worsening symptoms in addition to the potential for injury....we say on time every time is the best idea.... Sleepiness from SInemet; go low and slow when moving up dosages. As disease duration gets longer sometimes slightly reducing the dose and decreasing the medication intervals can help if it is causing drowsiness.
  5. My pleasure.
  6. The best way to differentiate PD from drug induced parkinsonism is by seeing an expert for a careful history and examination and then being followed for many months. It is likely based on your story that she has PD and is undermedicated on the Pramipexole and may need to slowly go up on the dose and make sure the timing is adequate. Watch out for impulse control disorders and other side effects. Depending on age and other factors in the US many docs would use straight SInemet or Madopar plus a MAO-B and exercise.....hard to know without seeing her.
  7. Not sure about the timing but I have seen patients who seem to tolerate the addition of the second memory enhancing drug poorly....
  8. When we say capture we often mean that we achieve the clinical benefit desired (e.g. the DBS captures the tremor to the satisfaction of the patient).
  9. It is hard to judge without seeing you but the approach of increasing STN stimulation slowly to get below the dyskinesia threshold will be helpful and over time in many cases you can begin to capture dystonia and dyskinesia. This would be my approach. I would not rule out adding GPi DBS later after you try settings and also medication for 6-12 months.
  10. This type of painful symptom you respond is not commonly observed with PD.
  11. We generally treat with dopamine agonists and dopamine replacement and any of a variety of antidepressants but in some cases just the dopamine agonist and/or replacement really helps with the depression (especially early). The dose of the agonist she was given would usually be too low to help that. Generally Zoloft doses of 100mg and up are helpful and impulse control and suicidal ideation in particular should be monitored.
  12. early onset pd

    There are some features here that could be Parkinson related and I would definitely get a second opinion. The tremor is not classic, but it is more on one side of your body and worsens and becomes more continuous when you walk. Best to see a movement disorders doc and get a full history and exam.
  13. I think it is great to find something that works and of course you and your doc can slowly increase the other doses and monitor for benefits and side effects.
  14. I am not aware of any good data to support this use in humans. You have to be very careful with antibiotics for general health concerns so we usually focus the decision on the GI docs assessment of needs.
  15. early onset pd

    I would not get discouraged but would recommend before doing anything else going to the other specialist right away.