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Dr. Okun

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Everything posted by Dr. Okun

  1. I am concerned about seizures and sometimes it is helpful to go into a seizure monitoring unit or to get an ambulatory study. Some people will get a MRI to look for a stroke that may be the genesis of the seizure. Some people will even after EEG and workup treat with meds. Lewy Body disease can cause these sorts of episodes but these sound more severe than Lewy Body.
  2. Sinemet Use

    You may try a half of a tablet every 3 or 4 hours and that may help a lot (Sinemet 25/250). Also be careful as the artane may worsen cognition and some people will not use this drug. Mucuna pruriens can be added to the Sinemet as another option.
  3. This is possible and we have seen this in a few patients. Usually when it occurs a dystonia or something really uncomfortable emerges on the least affected side--and then patients switch and say that is the more affected side. I think the key is to listen to the patient and to treat the symptoms as with treatment you may be able to handle the symptoms and treat them effectively (botox for dystonia, levodopa, etc.).
  4. Can frequency be used to reduce side effects

    Certainly the programmer can try lower frequencies and other adjustments to improve speech. One issue that we have seen is that when you start to get below 100Hz the resting tremor may re-emerge. Programming around speech issues has been a challenge....
  5. Curcuma and Coconut Oil in Parkinsons

    We have not yet seen the evidence to support the claims, though the safety profile seems good. I have not been recommending this approach with my patients so I could not advise on dose. I will post for you.
  6. Parkinson and Rheumatoid Arthiritis

    We are always happy to help. Remember to also use the 18004PDINFO helpline.
  7. Panic Attacks or Something Else?

    Posting for you. On Neupro and other agonists remember to monitor for impulse control behaviors (even if less on the patch).
  8. medication and time change

    We base this on your symptoms. Your doc sets timing to avoid wearing off and adds dosages. Usually if you move from say 3 to 2 hour dosing, this will add several doses at the end of the day.
  9. Are we doing everything right?

    Vitamins and supplements do not have much data to support their use in PD and I do not recommend to my patients more than a multi-vitamin. The ones you list look reasonably safe, but be careful of cost. Mucuna is just another levodopa formulation and not sure this will help by replacing. For the orthostatic hypotension we use compression stockings, hydration (6-8 glasses of water a day) and salt. We also sometimes use Florifef, Midodrine, or Droxidopa. We have a 18004PD INFO free helpline too. Hope that helps.
  10. Prolopa

    I do not believe there is any difference as both can cause dyskinesia.
  11. Prolopa

    Prolopa and Sinemet are essentially both dopamine and different varieties are available in different countries. In early PD you can use these alone, or an agonist alone or a combination. They are both safe with MAO-B drugs like selegiline and rasagiline. I choose based on a detailed history, exam, and potential side effects.
  12. Increased sense of smell

    Great question. The best I can tell you is my experience and I have not yet heard this from a PD patient.
  13. Switch from Neupro to Ropinorole

    This is usually a process and the right doses and approaches will need to be implemented. In some cases it may replace the Requip but in others it may not. Re-dosing Sinemet when awakening is also a great strategy. We tell patient to keep working with their doc and refine doses based on responses and symptoms.
  14. Hemp Oil vs CBD Oil

    There is not a lot of data on this and we need more data to be safe. I tell my patients not to take these things off the internet or stores because of the contamination issue that has left many people in the emergency room. Best to use a prescription from a doc with monitoring.
  15. Suicide

    Thanks for the note. In my experience Sinemet does not cause depression or suicidality; it is the PD itself and levodopa and other treatments (antidepressants and also TMS, ECT) can be used. Hope that gives you some piece of mind and hang in there.
  16. Frequent urination when reclining

    Very common in PD and usually not levodopa but constipation can contribute. Best to discuss with your doc and get a urology consult. Watch out for drugs that can worsen cognition. There may also be exercises that can help.
  17. Untreatable Dyskinesia

    We usually will try lower doses of carbidopa/levodopa or madopar and give them more frequently and often we simply to just this one PD med. If that approach doesn't work we may try duopa or DBS. I have not had much luck with Mucuna in this setting, but little experience.
  18. Is this RLS?

    This does not sound like RLS, but could be.... Safinamide or a MAO-B would not personally be my choice. Usually I use doses of levodopa at night for re-emergence of symptoms such as cramping or dystonia. I would ask your doc about that possibility. Hope that is helpful!
  19. I would not draw that conclusion based on the data and also based on the fact that so many people with PD have REM sleep disorder. We will watch the literature but I do not interpret this symptom in that way.
  20. Diagnosed today

    Great news. Don;t be afraid of the PD drugs when administered by experienced docs as you have found!
  21. Does Curcumin prolong the QT interval?

    I do not know the answer for curcurmin as we do not use it in our clinic and there is little data in PD. QT should be checked if you are on the Nilotinib trial but how often and in what way I would ask a Hem-Onc doc as this is used for leukemia. I suspect they do the monitoring in office! Hope that helps.
  22. Vitamins and sun exposure in PD

    I do not recommend more than a multivitamin a day. Also watch for vitamin toxicity as you can overdue it and it can be costly. Go over the list of anything you may want to take to look for interactions and safety with your doc/pharmacist. Melanoma is more common in PD. Sun exposure is fine as long as you use sunscreen. I am unaware of a worry in PD with sun and free radicals.
  23. Parkinson and Rheumatoid Arthiritis

    See my previous response on this. Usually ok to take but needs to be monitored by neurologist and rheumatologist.
  24. Parkinson and Rheumatoid Arthiritis

    So far in our patients we work with the rhematologist and watch for symptoms of Parkinsonism but in most cases these meds can be used together.