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Dr. Okun

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Everything posted by Dr. Okun

  1. My pleasure.
  2. That type of tingling is often arthritis in the back or a slipped disk. There are many causes and Parkinson would be down the list of possibilities based on your description.
  3. Thank you and feel free to ask any followup questions.
  4. At this moment we are not recommending replacement of another MAO-B inhibitor that may be working fine. It will take some time to sort out how we may use this drug in the Parkinson cocktail.
  5. In most cases the motor symptoms occur first. Sensory symptoms occur in a small minority of PD patients.
  6. I have not heard that this is harmful, but you may want to ask your doc. It is very unusual that a sleep doc would not study a PD patient. You should consider a different sleep doc.
  7. I usually recommend using one multivitamin a day and I agree not to overdo it. Maximizing dose and adjusting interval of one drug before adding others is good medicine.
  8. There is not too much data on melevodpa, but when this compound was conceived it was hoped it would give quicker on's. It doesn't look so far like it is much different than levodopa, but we need more data as there may be an advantage. In your case regardless of the formulation I would suggest moving doses to every 2 hours and consider adding either pimavanserin, quetiapine, or clozapine to his regimen for hallucinations. You may ask your doc about this. You could also reduce Dopamine by 1/2 tab at each dose and see if he stays on at 2 hour intervals. A dopamine pump or DBS may also be a consideration if hallucinations can be controlled. Format: Abstract Send to Clin Neuropharmacol. 2010 Mar-Apr;33(2):61-6. doi: 10.1097/WNF.0b013e3181c5e60c. Clinical experiences with levodopa methylester (melevodopa) in patients with Parkinson disease experiencing motor fluctuations: an open-label observational study. Zangaglia R1, Stocchi F, Sciarretta M, Antonini A, Mancini F, Guidi M, Martignoni E, Pacchetti C. Author information Abstract INTRODUCTION: Slow gastric emptying decreasing levodopa (LD) bioavailability contributes to motor fluctuations in Parkinson disease (PD). Melevodopa (LD methylester), ensuring rapid duodenal absorption, has been proposed as rescue therapy for afternoon off periods. OBJECTIVE: To assess daily motor fluctuations by multiple administrations of Sirio (Chiesi Farmaceutici SpA, Parma, Italy) (melevodopa/carbidopa) in PD patients. PATIENTS AND METHODS: In this open-label naturalistic study, 75 PD patients (group A) completely switched standard LD (Sinemet or Madopar) with Sirio at an equivalent dosage (800-1000 mg/d). One hundred nineteen PD patients (group partially replaced their standard LD (Sinemet) with Sirio at an equivalent dosage (400-500 mg/d) while continuing Stalevo 100. In both groups, the observational period lasted 6 months. Assessments included an on/off diary, the Unified Parkinson's Disease Rating Scale (motor examination [UPDRS II] and activities of daily living [UPDRS III]), the dyskinesia scale, and an adverse event profile. RESULTS: Group A showed a significant reduction of afternoon off hours at 6 months (P < 0.05). Forty-five patients (69%) reported a subjective early onset of on motor response. Twelve patients (18.5%) reported its shorter duration. The dyskinesia scale score remained unchanged. Ten patients (13.3%) discontinued melevodopa for gastric intolerance. Group B showed at 6 months a significant reduction of total hours of daily off periods (P < 0.05), particularly in the morning (P < 0.01) and afternoon (P < 0.05). Seventy subjects (59%) expressed positive judgment on quickness of onset of on motor response. The dyskinesia scale score was unchanged. No significant adverse events were reported. CONCLUSIONS: Switching PD patients with motor fluctuations to melevodopa, particularly in the presence of entacapone, could optimize critical periods of the day such as the morning delay on and afternoon off periods. PMID: 19935405 DOI: 10.1097/WNF.0b013e3181c5e60c
  9. We don't know yet, but the evidence suggests that it is about the same as the other MAO-B inhibitors. It provides some increased on time, but the idea that it would be super helpful for dyskinesia or a strong drug for cognition has not been supported by the data.
  10. This is a good question. The easier strategy is to keep the doses the same and move to strict 3 hour intervals. CR generally gives 80% of the pop of IR, so you have to figure that in if you try the above strategy. Honestly it is trial and error, but most of the time the intervals are more important than the dose or mixing. Hope that helps.
  11. Thanks. Be careful with agonists as the ICD can show up at any dose; some studies say less with lower doses and some say less with the patch. As far as Sinemet or Madopar use as much as you need to control symptoms as we do not recommend under-dosing. Hope that helps!
  12. Terrific I am so glad you found someone.
  13. The safest technique is actually not a sleep pill. It is simply to redose Sinemet or Madopar if you awaken at night. A sleep study could be useful as could a small dose of clonazepam. In some cases melatonin may make sleep worse. Hope that helps.
  14. You can get sensory changes on the side of the body your Parkinson start's on (or your worse side); however this sounds more like a disc compression or nerve compression. Best to see a neurologist. If it resolves with dopamine it could be PD related.
  15. This is possible but also may be from too low of a dose. Also, be careful with side effects of agonists such as impulse control disorders (shopping, gambling, hypersexuality).
  16. Yes the sedative meds you took we have heard can improve PD symptoms for many hours but we do not recommend their chronic use. The Rytary in some of our patients has resulted in stomach issues and we switch back to Sinemet in these cases. Taking SInemet at more frequent time intervals may solve your wearing off. Hope you feel better.
  17. We usually try different SSRI's or SNRI's or TCA's for depression in Parkinson and different patients may need different meds. It depends on side effects and also in some cases how fats you metabolize drugs. When a depression drug is stopped for side effects it may lead to recurrence of depression and a risk of feeling suicidal so be careful.
  18. Our 18004PDINFO helpline can assist talking you through this issue. In general if you bring his medicines on a plan to the US and have the bottles and presciptions in the bag it is usually not a problem. This is the same for Mexico I think. You can get a doctor in the US to write prescriptions for what you need and it can be any doctor (family or even a doc in the box) though they may be expensive. The meds like dopamine agonists, Sinemet, etc. are available however some of the sedatives and other meds are not. Our 18004PDINFO can help you through your list. Safe travels.
  19. I do not know if you could have done something differently but weight loss occurs commonly in Parkinson and also other neurodegenerative conditions. Because these conditions affect brain systems important to weight they can sometimes be hard to treat even with increasing calories.
  20. It sounds like your doctor may not have the expertise to tell if you have Parkinson or something else. Referral to a specialist in movement disorders may be helpful. Some of your symptoms sound like PD and others do not and in that case I would be suspicious that something other than PD is going on. A DAT scan could tell a doc with less expertise whether there is a dopamine issue and that may be worth pursuing.
  21. Your symptoms could be consistent with Parkinson and your age at 47 would not eliminate Parkinson. One sided symptoms as you describe with associated pain and dystonic postures could definitely be PD. I would suggest you see a neurologist or movement expert. I would not however try to self diagnose as in some cases you may be wrong. If you have PD, based on your description I would anticipate this to be very treatable and for you to do very well.
  22. I have observed cold symptoms as a wearing off phenomenon and in many cases moving doses closer together is the solution. You may ask your doc for example to move doses to every 3 hours instead of 3.5. Hope that is helpful!
  23. This is usually not Parkinson related and I suggest seeing an ENT doc as it is not a good idea to keep taking prednisone (in general). Good luck.
  24. This could be sundowning or worsening cognition at night. Strategies that may be helpful include reducing pump rate toward the end of the day, reducing sinemet, agonists or other medications---but watch out as reductions can lead to worsening of PD symptoms. Since she is at max dose of Nuplazid one could ask your doc about a trial or stopping or possibly adding seroquel or clozapine. It is certianly possible NuPlazid worsened symptoms.
  25. Thanks for the question. Please see previous reply but in summary dopamine agonists can cause coughing and also soughing while eating could be a sign of aspiration and lead to pneumonia.