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Dr. Okun

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Dr. Okun last won the day on January 23

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About Dr. Okun

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    University of Florida
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    Parkinson disease and movement disorders
  1. Timing of Sinemet vs increased dose

    Some people do get groggy at higher dosage and we indeed drop the dosage and also give the drug more frequently. We may also add an agonist (keep monitoring for side effects of agonists like impulse control and sleepiness).....then we consider DBS for the tremor.
  2. Help with questionable diagnosis

    Usually Sinemet is the next step and is usually helpful (under a doc's guidance). I add this to Sinemet. Azilect rarely causes these issues you describe.
  3. PD induced Camptocormia

    I will post this for you as there are not a lot of treatment options. Physical therapy, stretching, exercise and occassionally muscle biopsy is helpful.
  4. rasagaline side effect

    Usually the faster treatments for off dystonia are Sinemet (or Madopar) and/or botox.
  5. Amantadine & Triglycerides

    Thanks for the comments. Interesting on the weight loss....
  6. Camptocormia

    I will post this for you. We have not found a great treatment for camptocormia and we usually do physical therapy, stretching and exercise. There are occassional reports of muscle disease underpinning a few cases (need a biopsy for this if your doc thinks possible).
  7. Misdiagnosed?

    In most cases this turns out to be PDD or PD dementia. If it occurs in the first 5 years after diagnosis it is more likely Lewy Body disease. Your instinct that the higher dose of med may be hurting could be correct, and sometimes a lower dose more frequently is helpful. Another thing that sometimes helps is Aricept or a similar drug like Exelon. The internet is a hard place to make a diagnosis so you may want to share with your doc as occasionally rare things like seizures can be causing issues. Many of us have 2nd opinion programs for people overseas and we can help you if this is needed. Good luck sorting this out.
  8. Orthostatic Hypotension

    Good luck!
  9. boxing

    Thanks for the comments.
  10. This does not sound like regular PD and I would consider another diagnosis like Lewy Body Disease or PD + Alzheimer's. I personally do not use agonists like Mirapex in these situations....sleep attacks, confusion etc. I use Sinemet and sometimes add Aricept. I cannot comment on stage but perhaps management could improve her condition. Good luck.
  11. husband and wife, both with young onset PD?

    Agree, this is rare. We have seen husband's and wives with PD but not usually early PD. Maybe there was something occupational for you both (resins etc.)?
  12. Amantadine & Triglycerides

    This was in a non-PD group but did not show a change in TG's. Double-Blind, Placebo-Controlled Investigation of Amantadine for Weight Loss in Subjects Who Gained Weight With Olanzapine Karen A. Graham, M.Sc., M.D., Hongbin Gu, Ph.D., Jeffrey A. Lieberman, M.D., Joyce B. Harp, M.D., and Diana O. Perkins, M.D., M.P.H.
  13. Amantadine & Triglycerides

    Very interesting. I have not noticed an association between amantadine and Triglycerides.
  14. Dopamine Repsponsive Dystonia

    We have seen DRD present looking just like PD. I cannot recall if I have seen REM sleep behavior with DRD but it is reported in the literature.
  15. rasagaline side effect

    Dyskinesia and dystonia are rarely seen as a result of rasagaline. Be careful blaming rasagiline. Usually but not always dystonia is undermedication. Dyskinesia is over-medication (in general terms).