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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. Dystonia and early onset

    I can't remember the paper but it was a recent one published on the PPMI initiative. Basically several people enrolled had a negative DAT and later on down the road converted to a positive DAT,
  2. Dementia Lewy Bodies

    In our practice as long as you are monitored by your doc it is usually safe. We do not however do this with dopamine replacement (Sinemet/Maodopar).
  3. dbs and duopa pump

    It usually isn's a number of years issue. First, it is choosing the right candidates for DBS and understanding what does and does not improve and what may worsen...so in your case is the DBS in the right brain location? Did it help tremor, stiffness, slowness, on-off fluctuations, dyskinesia? DBS is known to worsen speech and not help walking, talking and speaking. For Duopa adding it could help motor fluctuations and dopamine responsive symptoms but not walking, talking or thinking. I know it is complicated, but it really doesn't come down to a number of years of working or not working. It is a balance and the DBS and pump help symptoms that are dopamine responsive but do not stop progression....progression speed is different in everyone and hard to predict. I am sure it is very frustrating and I am so sorry there is not a simple answer for your question.
  4. I think the DAT scan will help you and your doc make the right decision and lead you to a more clear diagnosis.
  5. PD phenotypes and the Outcome Initiative

    Much of the phenotype work around the world is trying to link to potential causes.
  6. Leg Shakes

    You should see a specialty neurologist and the decision needs to be made whether this is Parkinson's disease or orthostatic tremor (a tremor that occurs on standing). This should be treatable.
  7. Robotics vs ClearPoint DBS

    The robot is just a system where the brain coordinates are programmed into a robot and it helps with the DBS. We are very concerned about these systems as the location of the DBS should be chosen by direct human visualization of the target on MRI. We have seen some groups depend too much on the robot. The other system is a one where the procedure can be done in the MRI without physiology or microelectrode recording. This is a new system, but in experienced hands seems to be working reasonably well. Look for experience and track record with any technique you choose for DBS.
  8. YOPD or Atypical?

    In general this does not sound like atypical PD. It sounds like typical PD and you may ask your doc about simply moving doses closer together and also considering DBS or Duopa...
  9. Hallucinations in Luvy Body dementia

    Best to see a neurologist immediately and to assess whether there is a UTI and also whether medication regimens can be simplified (stop Comtan, Amantadine, MAO-B, anticholinergics)....we like Sinemet only regimens. If this doesn;t work you should continue to work with your neurologist on adding seroquel, clozaril, or pimavanserin as these can help without worsening PD. Hope that helps.
  10. Dystonia and early onset

    One recent paper said that a negative DAT scan is a potential predictor of a future positive DAT scan. Your course could certainly be young onset PD and you may want to seek a second opinion. Our 18004PDINFO helpline can assist in connecting you.
  11. Dementia Lewy Bodies

    We have a free 18004PDINFO helpline and that is something you or he could call.
  12. Dementia Lewy Bodies

    Thanks for the detailed message and question. In my clinic I have found drugs like exelon and aricept much more useful than Namenda. I add them one at a time and sometimes they can worsen the situation. I have for example seen the addition of Namenda be worse for patients. I would not hesitate to work through options with your doc. Hope that helps.
  13. Carbidopa alternative

    My pleasure.
  14. status of new drug

    Hi Noah, the current information I have that is public is that is has not passed the FDA for approval. We will keep our eyes on what is the publicly available data on this drug.
  15. Newly Diagnosed - Some Atypical Symptoms

    Our pleasure.