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Dr. Okun

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Everything posted by Dr. Okun

  1. Our pleasure.
  2. I do not have any experience with that cardiac drug and exelon so I would have to advise you to ask your pharmacist and then circle back to your doc. I personally use Aricept and Exelon interchange-ably if one is cheaper than another and I am not married to patch versus pill.....it may provide mild memory improvement in some patients. Reading the story I wonder if you and your doc should dose the Sinemet at closer intervals and make sure each dose is correct for his symptoms and side effects....
  3. Mucuna is essentially a form of dopamine, so I do not think there is any data to suggest it is better than Sinemet at early stages.
  4. I can't speak for the panel, but of course most panels sponsored by a major foundation provide excellent tips that can be taken to your doc for local advice.... In some people your proposed strategy may work, but in others likely not....
  5. It is possible it could be craniofacial dystonia or sometimes referred to as Meige syndrome; seeing an expert is a great idea.
  6. Possible but NBIA usually looks different and a brain MRI shows a lot of iron in specific areas....
  7. Sinemet has a short half life in the neighborhood of 1-2 hours but in early PD it lasts longer and in more progressive and longer duration PD it may last shorter intervals. That is why it is necessary to change dosing intervals as the disease progresses.
  8. It is possible the seroquel was helping; but in shortness of breath cases giving meds more frequently is usually helpful even if the dose is reduced. So for example in some cases 1/2 tab of Sinemet but every 3 hours.....Some people may tolerate a higher dose but others may get psychotic and this is the balance you strike by working with your health care team. That is a general illustration and not meant to apply to a specific case.
  9. PET is considered safe but only a few places in the USA do it well and interpret it accurately so in general I do very few of them. The easier test is a DAT scan which can inform about whether dopamine is involved. If completely negative DAT less likely Parkinson compared to ET. DAT does not give exact diagnosis and could be other parkinsonisms if positive.
  10. I would not insist on brand Sinemet. You may want to try 1 tablet then 1.5 tablets and then 2 tablets and choose the best dose (instead of jumping from 1 to 2 tabs.
  11. Sinemet is ok to start with and we use it all the time as the first line. If you use a dopamine agonist then we recommend monitoring for impulse control and other side effects.
  12. My pleasure.
  13. In general 150's systolic during sleep I generally do not treat. Some people will add extra doses of levodopa at night when people awaken to go to the bathroom. Levodopa will reduce BP and also the PD autonomic issues are worsened just from disease progression.
  14. This may be duplicative of my last response but key questions for your doc? What Parkinson syndrome does he/she think you have? What is the response to levodopa? Resting tremors are often quite responsive to levodopa.
  15. We would need more information. I think the key question for your doc is how is your response to levodopa is and what alternative diagnosis is your doc considering?
  16. Rasagiline and generic selegiline seem to give about equivalent symptomatic benefits in trials. Certainly Sinemet or dopamine agonists would be the next step or both if the tremor remains an issue. I usually use Sinemet as the next step in situations such as yours. If you can't get all the options on the table maybe you could consider a second opinion as the choice should be yours!
  17. Not necessarily. We will start with Sinemet if the symptoms are severe and disabling.....we choose cases by case.
  18. Swallowing issues are common and progressive in PD/ The other issues like hemibody numbness and scleroderma are not associated with PD.
  19. Great question. Actually as in many medical issues in the human body, it turns out it is very possible to in this particular case to function with this nerve cut to the stomach. Pretty amazing!
  20. I have not seen any information that has compelled me to stop finasteride in any of my patients. Some patients on prostate meds have other side effects such as fatigue and that may be a more plausible reason to stop this drug. The decreased levels of brain chemicals and effects on PD at this point are speculative.
  21. Yes, we have many patients who push it too hard. Basically you want to exercise to feel good the next day; if it makes you tired or fatigued then we usually decrease the amount of exercise.
  22. There is no right way to do this, but usually I start with daily exercise and a MAO-B inhibitor. If the tremor persists then I usually add Sinemet 25/100 1/2 a tab every 5 hours or so and each week increase by a half tab until the tremor comes under control...
  23. It is unfortunately impossible to comment on your question since I have not seen you. Can you possibly see a different neurologist sooner?
  24. Actually the dosing for symptoms in individual patients is quite variable and in my experience there are no hard rules.
  25. Thanks for the update.