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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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  • Location
    University of Florida
  • Interests
    Parkinson disease and movement disorders
  1. Dr. Okun

    symptom questions

    Complex question but it is not always related to dopamine and the brain circuits involved in Parkinson and movement disorders are called basal ganglia---and stress affects this brain system.
  2. Dr. Okun

    freezing gait

    Thanks for the comment.
  3. Dr. Okun

    Rest twitch on occasion?

    Hard to know but occasional twitch can be seen in people without Parkinson. Sometimes in Parkinson a twitch is myoclonus and is not worrisome (in most cases).
  4. Dr. Okun

    Strange symptom PD?

    One suggestion since this is complex and you have peripheral neuropathy, autonomic symptoms, and GI symptoms is to ask your doc about the possibility of MSA and to also pursue a neuromuscular consult for workup of neuropathy and other causes. These symptoms seem beyond plain Parkinson but certainly can all occur with Parkinson. Sometimes in extreme cases botox to the legs helps and/or methadone or an opioid.
  5. Dr. Okun

    Timing of Medication

    It is not one size fits all and you could try it and see if it works for you. Most of my patients do better on strict time intervals but a few succeed with other strategies,
  6. Dr. Okun


    I doubt the Zoloft would worsen, and I would definitely pursue the possibility of clozapine.
  7. Dr. Okun

    Frameless deep brain stimulation

    Look at the websites for Leksell head frames and CRW head frames. I think the CRW is more accommodating. Several people like Dr. Foote at UF use a CRW.
  8. Dr. Okun

    Parkinsons symtoms

    This is very hard to determine. It depends on the medication given and all of your underlying diagnoses (PD, bipolar etc.). Best to see a movement specialist to get the actual movement diagnosed and also to balance against the underlying disorder(s). Hope that helps.
  9. Dr. Okun

    B6 supplementation to correct deficiency

    Too much B6 can cause neuropathy so we recommend what is in daily over the counter multi-vitamins. We then recommend that levels are followed by your doctor and care taken not to overdose.
  10. I evaluate the patient on and off medications. If only on medication it is likely from the dopamine and I adjust dose and interval and consider amantadine. If off the medication for 12 hours and still present I consider botulinum toxin. This is an oversimplification, but usually where I start....
  11. Dr. Okun


    I use all the data in my practice and I also use an examination as well as the data from the PF Quality Outcome Project (QII) and other studies as well as my own observations over many years.....there is no standardization so I like to individualize to each patient.
  12. Dr. Okun


    This could be PD related but also can be heart or lung related. Generally we have the primary care doc check out heart and lungs. Then on the PD side we try to make sure doses and intervals are ok. Finally if bothersome after that we ask the speech therapist to do expiratory muscle strength training (EMST). Cannabis can also sometimes help with breathing as in many cases there is an anxiety component from the Parkinson.
  13. Dr. Okun


    Almost all antipsychotics have attached to them an increase in mortality. We wrote about this in JAMA Neurology as there is a significant risk of not treating someone with psychosis. Each doctor and each patient need to discuss the risk/benefit and make a decision that feels comfortable. Over the years we have used antipsychotics (clozapine, seroquel, and Nuplazid) very successfully and they have enhanced quality of life in our outpatient population. These drugs do carry a small extra risk and this requires discussion. Hope that helps.