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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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    University of Florida
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    Parkinson disease and movement disorders

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  1. 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.
  2. 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.
  3. 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.
  4. 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
  5. 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.
  6. 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.
  7. Dr. Okun

    Acid indigestion

    In these complex cases we work with the GI doc who will often do a quick scope, workup and in many cases safely add an acid blocker (Nexium or nexium like drug). In cases where dopamine replacement is causing some of the symptoms we add carbidopa to the levodopa or rytary and also consider adding domperidone. In cases where the cause cannot be pinned down we sometimes use domperidone and occasionally use Zofran but never drugs like metoclopramide that block dopamine.
  8. Dr. Okun

    Insulin growth factors

    One thing I always remind people is the difference between associated risk factors and actual disease. Once you have Parkinson or Alzheimer's the cat is out if the bag and it is not clear these sorts of interventions will be helpful. In other words many of these studies are focusing on risk and what may impact development of Parkinson. Having said that, there is a lot of interest in the endocrine system and insulin system and neurodegenerative diseases....there may be opportunities and clues here that researchers can use to address risk and address treatment!
  9. Yes, adding dopaminergics and agonists can result in extra movement (dyskinesia)--however this doesn't mean taking more medicine as your doctor suggests is wrong (it is probably a good idea to think of dopamine or an agonist). I tend to use more levodopa than agonist after DBS but it is not wrong to use agonist. Also, the laughter issue can occur usually as a result of the location of the DBS lead. Be careful with continuing to increase voltage as that can result in side effects....
  10. Awake jerking (myoclonus) is usually not a core symptom of Parkinson, but can appear after long durations of disease (perhaps from Lewy Body protein deposition).
  11. Dr. Okun

    Me and deep brain stimulation

    Can you define lesion? Is this a brain lesion like a tumor, or a previous ablative brain lesion (pallidotomy. etc.)?
  12. Dr. Okun

    Can DBS cause severe muscle pain?

    Speech is the most common side effect of DBS and also getting words out of the mouth. Pain and shaking is uncommon, but if the device is turned off you can usually determine if the DBS is causative. Sometimes when the device is on, it can precipitate "on" dystonia with pain. I think after several months of trying programming and medication changes if issues persist we do a workup including imaging and checking thresholds for benefits and side effects at each contact on the DBS lead(s).....ask your doc about these.... Not sure on shaking night episodes but re-emergence of symptoms and redosing SInemet or Madopar at night are reasonable strategies.
  13. Dr. Okun

    Thoughts on my neurologist's diagnosis

    I think the levodopa trial is important to clarify diagnosis as you describe it, but remember it could take 12 weeks or more and the dose may need to be increased to 2 or more tablets per dose to be sure. After the trial you and your doc would select the best/optimal dose and also discuss whether symptoms are affecting quality of life or if your examination suggests harm from not treating (falls, etc.). Hope that helps. I would work with your doc on the trial and get re-examined at various dose levels before concluding whether the medicine is helpful and I prefer to treat for many weeks....also if you decide to stop we never sop abruptly as there could be a withdrawal syndrome.
  14. Dr. Okun

    A Flutter or A Fib

    Most people do not require more than 300mg of dopamine per dose (Sinemet) but best to titrate with your doc. Treating constipation can be important and improve quality of life. Anytime walking worsens breathing we always get an internist involved to look at the heart and lungs. Finally in some of these cases simply moving doses closer together at 2 or 3 hour intervals may improve shortness of breath or anxiety feelings. Good luck.