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Dr. Okun

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Everything posted by Dr. Okun

  1. Dr. Okun

    Startle Reflex

    Thanks for the comment. Occassonally Keppra is helpful or clonazepam but these can be sedating and sometimes have behavioral side effects.
  2. Dr. Okun


    It varies considerably and we do not talk in averages. We start low and go slow on titrations. Dizziness can be seen but is uncommon. Usually a slower titration helps.
  3. Dr. Okun

    Weight loss

    Good luck.
  4. Dr. Okun

    Running out of energy

    We have heard the same story many times.
  5. Dr. Okun

    First treatment?

    These are reasonable therapies.....studies show Azilect does not at 1mg dose interact with Zoloft and SSRI in almost all cases. Most people use Sinemet or Madopar more than twice a day as the half life is short.
  6. Dr. Okun

    Requip/Ropinirole and weight gain

    In a subset of patients it causes weight gain. In some patients it is impulse control and earting but in others we see weight gain without ICD.
  7. Dr. Okun

    Dyskinesia vs Akinesia

    It is not clear at this time but we see akinesia and dyskinenesia in patients without tremor.
  8. Dr. Okun


    This is a tricky question as there is no right answer. If you start with an agonist monitor for impulse control and have a family member observe you and report to the doc. Many people now start with Sinemet or Madopar without issue. Some people prefer Sinemet if over the age of 70 but there are no hard and fast rules. Whatever you choose, monitor the symptoms and adjust slowly.
  9. Dr. Okun

    Madopar vs Madopar HBS

    Its possible it may improve. Also you may add some carbidopa or benserazide. Sometimes going lower and slower on doses also helps to build tolerance.
  10. Dr. Okun

    Me and deep brain stimulation

    These cases are tricky and it depends on a case by case basis. A lot comes down to the symptoms and whether you respond to levodopa and choosing the target. Some of these cases do improve.
  11. This recent study from the Vanderbilt COE revealed that STN DBS worsened motor aspects of language and grammatical function (but not the content of language). Patients seeking STN DBS should be aware of this potential impairment. The abstract is provided below: PLoS One. 2012;7(:e42829. Epub 2012 Aug 7. Subthalamic nucleus deep brain stimulation impacts language in early Parkinson's disease. Phillips L, Litcofsky KA, Pelster M, Gelfand M, Ullman MT, Charles PD. Source Department of Neurology, Vanderbilt University, Nashville, Tennessee, United States of America. Abstract Although deep brain stimulation (DBS) of the basal ganglia improves motor outcomes in Parkinson's disease (PD), its effects on cognition, including language, remain unclear. This study examined the impact of subthalamic nucleus (STN) DBS on two fundamental capacities of language, grammatical and lexical functions. These functions were tested with the production of regular and irregular past-tenses, which contrast aspects of grammatical (regulars) and lexical (irregulars) processing while controlling for multiple potentially confounding factors. Aspects of the motor system were tested by contrasting the naming of manipulated (motor) and non-manipulated (non-motor) objects. Performance was compared between healthy controls and early-stage PD patients treated with either DBS/medications or medications alone. Patients were assessed on and off treatment, with controls following a parallel testing schedule. STN-DBS improved naming of manipulated (motor) but not non-manipulated (non-motor) objects, as compared to both controls and patients with just medications, who did not differ from each other across assessment sessions. In contrast, STN-DBS led to worse performance at regulars (grammar) but not irregulars (lexicon), as compared to the other two subject groups, who again did not differ. The results suggest that STN-DBS negatively impacts language in early PD, but may be specific in depressing aspects of grammatical and not lexical processing. The finding that STN-DBS affects both motor and grammar (but not lexical) functions strengthens the view that both depend on basal ganglia circuitry, although the mechanisms for its differential impact on the two (improved motor, impaired grammar) remain to be elucidated.
  12. This is a great post and illustrates the importance of not cutting back the medications too much after DBS. It also shows how attention to each issue was helpful. THANK YOU!
  13. Dr. Okun


    Usually it takes several weeks and you will need to keep dialing the dose up with your doctor as .25 per dose may be too low. We build up doses slowly and monitor for side effects such as impulse control disorders (shopping, gambling, etc.).
  14. Dr. Okun

    Weight loss

    Thanks for the question. There is a progressive weight loss that occurs in Parkinson's disease and other neurodegenerative conditions. Many studies are looking at the specific causes and reasons but there seems to be many associated factors. This is a free review on weight loss in PD available on Frontiers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040467/
  15. Dr. Okun


    Answers- Is apathy/anxiety/depression triggered by the on/off cycles of carbiodopa levodopa extended release **It is possible with any preparation of levodopa that you could get neuropsychiatric symptoms when wearing off. or is it because a missing chemical in your brain that is due to parkinsons disease that needs to be put in. **Not known but unlikely one chemical. Is there a test to determine if I am missing that chemical in my brain so then I would know that there is a need for my body to put that chemical in. **No. Is there a test to determine which antidepressant medication is more likely to help a person overcome depression/anxiety? **No. In the parkinsons community is it very common and does it have a good success rate with treatment? **Common and usually treatable. Also to complicate the matter I am on a blood thinner and the information that I see clearly states that SSRI and other forms of antidepressants will increase the risks of bleedly. So I wasn't sure if you have heard of any other parkinsonians that are taking both a blood thinner and a antidepressant. **Important to ask your PD doc and internist.
  16. Dr. Okun


    Yes, temperature regulation can be an autonomic symptom in Parkinson.
  17. Dr. Okun

    Nuplazid cost

    No generic I am aware of....you may consider Quetiapine or Clozapine as alternatives that may not worsen PD. Also, some companies have paperwork for people and programs that address cost if you can't afford.
  18. Dr. Okun

    Startle Reflex

    It is possible but not very common. You can talk with your doc about a switch to SInemet and see if it makes a difference.
  19. Dr. Okun

    Running out of energy

    Thanks for the question. Each person needs an individual evaluation to discover if there are issues that can be addressed by changing the exercise regimen, medications or other options.
  20. Dr. Okun

    Sinemet not wearing off

    It is hard to say but your doc may be correct that you are on the right dose and not wearing off. If you change doses and intervals you can assess with your doc and see if this is correct. You are not on much medication and your doc is probably correct. A second opinion is another option and bring your DAT scan for evaluation if you do a second opinion.
  21. Dr. Okun


    Some of what you describe may not be standard clinical practice and you may consider a second opinion. The 18004PDINFO helpline can help you locate one or more places.
  22. Dr. Okun

    symptom questions

    Complex question but it is not always related to dopamine and the brain circuits involved in Parkinson and movement disorders are called basal ganglia---and stress affects this brain system.