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Dr. Okun

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Dr. Okun last won the day on September 6

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About Dr. Okun

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    University of Florida
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    Parkinson disease and movement disorders
  1. Tremor-dominant subtype

    I am only commenting on Parkinson patients with tremor. Literature suggests that if you have tremor that 20% or more of cases will have an incomplete or no response to dopamine (only the tremor feature as the other features like rigidity usually respond). I am so sorry if I confused you!
  2. Stalevo and falling

    I accidentally approved this post for Mark's forum but if you allow me I will weigh in with an opinion. I have seen cases where Stalevo or higher doses of levodopa actually result in on freezing. When I encounter this I switch to regular release sinemet plus or minus an agonist and titrate to the dose that gives the best relief without precipitating freezing. Michael Okun, MD; my apologies to Mark for weighing in on his excellent forum.
  3. why turmeric is used for most of health issues ?

    Tumeric has been suggested by many people to have numerous health benefits. Since this is a PD forum I can only comment on PD and to date the data is not convincing for PD.
  4. Help with questionable diagnosis

    Thanks for the question. Based on many of your symptoms this could definitely be PD and you may want to get a second opinion from another neurologist or a DAT scan. If you get another opinion it may be useful to go to the appointment off dopamine medications overnight. Hope that helps. The description of fasciculations doesn't fit and maybe he/she can examine that and if these are not true electrophysiological fascics then it may all be PD.
  5. Paradoxical reaction to Sinemet

    Thanks for the question. Sometimes a paradoxical or no response to levodopa (dopamine) may be a clue to parkinsonism and not to PD-- but not always. In reading this post I am struck by the super low and then super high doses given (quickly). I would take a different approachand start at 1/2 tablet three time and a day and slowly titrate up and check back in regularly with the doctor for an examination to document benefits and potential worsening. Also important to document a baseline examination with the eye movement and walking. Occassionally at high dose levodopa can result in freezing/gait issues and also eye issues (oculogyric-like or eye dyskinesia). Hope that helps.
  6. The Spring "Parkinson Report" has an article on gut bacteria and H. pylori.  In the fifth paragraph you state: "researchers speculated H. pylori infections could be related to an increased risk of the development of PD. Their study...showed that the use of H. pylori-eradicating drugs was associated with a 45% increased risk of developing PD  Similarly, the use of proton-pump inhibitors was linked to a 23% increase risk of PD."  

    I am confused.  Should that read H. pylori eradicating drugs decreased the risk of deleloping PD rather than increased the risk? 

  7. In my opinion this is clearly a no answer. You should proceed to be treated with medication and levodopa and not have a hole burned in your brain for early Parkinson.
  8. Tremor-dominant subtype

    20-40% have some degree of resistance to tremor. Autopsy shows differences in tiers of the brainstem affected (nigra) between patients with tremor dominant PD and akinetic rigid PD. I am not aware of autopsies of medication resistant cases but this would be very interesting. Thanks for the questions.
  9. Yoga for Parkinson's

    Nothing yet.
  10. Sinemet Use

    Thank you.
  11. Tremor-dominant subtype

    Thanks for the question. 20-40% of patients have some or total levodopa resistance to tremor and so far the autopsies look like the same areas of the brain are affected as in tremor dominant PD (slightly different preference of cells in the substantia nigra (black substance of brainstem). Most patients with the symptoms you prescribe have slow progression and several papers are coming out about this. The GBA mutation may for example be a marker of faster progression especially in cognition. The Parkinson's Foundation and several other researchers have been using large databases to get at your question and see how PD progresses and how subtypes shift. One other thing to discuss is that most people need levodopa after DBS and it seems especially important for apathy, mood and neuropsychiatric symptoms.
  12. Panic Attacks or Something Else?

    Thanks for the note. Sometimes taking Sinemet doses closer together can eliminate this issue of wearing off shortness of breath or anxiety. That is a potentially good strategy to consider with your doc. Thanks for sharing,
  13. Sinemet Use

    One suggestion you may try is asking your doc about dosing Sinemet every 2 hours. There is also an artane tablet that is 2mg and if the benefits are the same at 2mg you will likely get less side effects.
  14. Azilect (Rasagiline)

    My pleasure.
  15. Curcuma and Coconut Oil in Parkinsons

    I have no experience with this as a PD drug, but in general it has been reported.