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Dr. Okun

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Everything posted by Dr. Okun

  1. I am concerned as a negative DAT this would not likely be PD. You may want to repeat the DAT. PD usually does not have episodes of night incontinence and you should see the neurologist and inquire about other causes of incontinence like seizures. If it is PD then I have no reluctance to use Sinemet and you should consider. If ET propranolol and primidone are the best drugs. In some cases DBS can help tremors where meds fall short.....hope that helps.
  2. Probably best to look in some textbooks of neurology like Bradley or Adams. There are tons of metabolic, infectious and degenerative conditions that have some symptoms that can look like PD.
  3. There are actually PD cases that have only rest tremor (confirmed by PET). ET can have problems with gait and balance so the difference can be hard in some cases. The dizziness doesn't sway me one way or the other. Without seeing you my guess is that you likely have ET. One other possibility with neck pain is dystonic tremor. There are deep brain stimulation techniques for all these tremors if meds do not help.
  4. Totally agree.
  5. This is a tough one. Some people get headaches that have tinnitus features and the fact that you get it upon wakening and also aftrer taking sinemet may be a clue you need to see a headache doc. One thing we usually so is get a MRI to rule out low pressure as a cause for the headaches.
  6. It is not clear the probiotic will help PD but so far we believe it is safe to take one.
  7. I personally think the statin and cholesterol area with PD risk has been very confusing across studies and needs clarity. At this time remember if you have PD risk is not an issue...because you already have PD. The treatment trials are interesting and I encourage people to enroll so we can get answers. Finally, when it comes to use of statin for cholesterol I usually strongly favor as long as the internist is on board.
  8. In cases like yours I usually seek a sleep study to find out what is going on. Sometimes clonazepam helps.
  9. In my patients I usually just start at 1mg.
  10. There are cases of PD that have mainly rest tremor so it is tricky. The lack of progression would make us question as to whether it is really PD.
  11. This is a really tricky situation. If there is any question between PD vs. ET there is a a scan called a DAT scan that is labelled to help differentiate.
  12. Steve, one option may be the Sinemet 50/200 which has a little more carbidopa. You should also have your docs send an appeal letter. I am so sorry to hear this!
  13. I am not familiar either with DGL, but will post. We use carbidopa and/or domperidone for nausea.
  14. Hard to know, but I bet it would be a little better with Duopa.
  15. My pleasure to help. Yes, I would monitor with your doc and adjust as needed if symptoms re-emerge.
  16. I will leave others to reply to these questions. We use carbidopa or domperidone for nausea in our practice. Good luck.
  17. Thanks for the question. There are too many to list. Some common Parkinson mimics are PSP, MSA, ley Body, and CBD. Here are link that may help: http://www.parkinson.org/understanding-parkinsons/diagnosis/Are-there-other-conditions-that-can-mimic-PD http://www.everydayhealth.com/parkinsons-disease/movement-disorders.aspx
  18. Usually normal in our experience but we need more data on this issue.
  19. We know suprisingly little on this topic of small bacterial overgrowth and Parkinson. We reviewed a paper on the PF What's Hot in Parkinson Blog recently and you may want to check that out. At this time it is unclear whether and in who to treat; also using antibiotics has the potential of harm. At this time most PD experts refer to GI experts as we wait for more studies. We believe it likely impacts outcomes and absorption. Here is the piece we recently wrote: http://www.parkinson.org/find-help/blogs/whats-hot/january-2015
  20. Thank you.
  21. Thanks for the comment Greg
  22. Carbidopa.... and a medication called domperidone not available in the US is helpful.
  23. Thank you and glad we could help.
  24. One other thought is that some cases of Sydenham's chorea or autoimmune/paraneoplastic can cause tongue issues. Something to ask your doc about.