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Dr. Okun

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Everything posted by Dr. Okun

  1. Untreatable Dyskinesia

    We ask new patients to hold meds starting the night before (so around 9-11 at night take your last dose). We can make a plan that includes local followup. If you want to see rehab specialists while at UF make sure you call and request PT, OT, Speech. This is our standard first visit and we will give you recommendations for local followup if you can't travel. It is common for people not to be able to travel. Most new patients request PT, OT, Speech and Swallowing as a minimum so they can take recommendations locally.
  2. I will post this comment for you! Happy holidays!
  3. Untreatable Dyskinesia

    I am not sure if this is directed at me but I work at the University of Florida in a city called Gainesville.
  4. Follow Up Sinemet Question

    Hang in there Bill and good luck.
  5. Barium swallowing study

    Thanks for the question. The dye is usually barium and it is usually safe. We use it all the time in Parkinson. Hope that helps.
  6. Energy

    Many people use exercise and also will examine potential medications that can be causing diminished energy. Sleep studies are also very useful as in many patients it is a hidden sleep disorder affecting energy....these are a few things to consider.
  7. Dystonia

    Yes, high doses of medicine, high pump settings and even some DBS settings can precipitate "on" dystonia.
  8. Follow Up Sinemet Question

    Its really hard to know but I doubt it. You and your doc can experiment with doses and figure it out. Based on the description many patients do well with an antidepressant and more frequent lower doses of sinemet (some component of anxiety). Sometimes I add clozapine which requires blood monitoring.
  9. B1 thiamine injections many studies done

    Merry Christmas.
  10. Follow Up Sinemet Question

    Can you help us by specifying exactly what symptoms you are attributing to the Lewy Body? What are the behavioral symptoms? Paranoia? Confusion? Other? Thanks.
  11. Incorrect. Amantadine can suppress dyskinesia in many cases. Entacapone (Stride-PD study) can worsen dyskinesia. I usually stop entacapone first and then adjust regular sinemet or madopar. If dyskinesia persists I may add amantadine.
  12. Me Again. Q about Sinemet Adjustment

    Our pleasure. Happy holidays.
  13. Untreatable Dyskinesia

    Yes, of course someone in our practice can help if you come down. Happy holidays.
  14. Constipation

    No, only manual disimpaction. If you need surgery then you are obstructed. Surgery is not the long term answer. We have a constipation formula on the UF Movement Disorders Site. Also you should ask your doc about new drugs for this issue.
  15. Sinemet 25-100mg

    Hard to say over the internet. Best if unsure to get a second opinion. 18004PDINFO- our helpline can assist. A DAT scan is sometimes useful.
  16. B1 thiamine injections many studies done

    It should not be a battle to start Sinemet- this is the best drug overall for PD. Levodopa phobia has taken over some practitioners but the evidence is that it is safe short and long term. We do not recommend B1 shots unless deficient on blood testing.
  17. Question about Link between dopamine and testosterone

    We actually studied this a number of years ago and even ran a trial TEST-PD which was negative- testosterone replacement did not help PD. Testosterone is depressed in PD and AD and we published this in Neurology many years ago. In PD it seems to be an effect from neurodegeneration and not from medications. Azilect will likely not impact.
  18. Here is the abstract. In general I agree that higher doses and disease duration are most important and that delaying Sinemet (Madopar) is not a good idea. This is a great discussion. Also remember you can reduce dose and give more frequently and change combinations of medicines.....as treatment. This is a great topic so I encourage discussion. Brain. 2014 Oct; 137(10): 2731–2742. Published online 2014 Jul 17. doi: 10.1093/brain/awu195 PMCID: PMC4163032 The modern pre-levodopa era of Parkinson’s disease: insights into motor complications from sub-Saharan Africa Roberto Cilia,1Albert Akpalu,2Fred Stephen Sarfo,3Momodou Cham,4Marianna Amboni,5,6Emanuele Cereda,7Margherita Fabbri,8Patrick Adjei,2John Akassi,3Alba Bonetti,1 and Gianni Pezzoli1 Author information ► Article notes ► Copyright and License information ► See "'Don't delay, start today': delaying levodopa does not delay motor complications." in volume 137 on page 2628. This article has been cited by other articles in PMC. Go to: Abstract During the past decade, a number of large drug trials suggested that the initiation of levodopa therapy should be delayed to reduce the risk of motor complications in patients with Parkinson’s disease. However, the relative contribution of the cumulative exposure to levodopa and of disease progression to the pathophysiology of motor fluctuations and dyskinesias is still poorly understood. In this 4-year multicentre study, we investigated a large cohort of patients with Parkinson’s disease in a sub-Saharan African country (Ghana), where access to medication is limited and the initiation of levodopa therapy often occurs many years after onset. The primary objective was to investigate whether the occurrence of motor complications is primarily related to the duration of levodopa therapy or to disease-related factors. Study design included a cross-sectional case-control analysis of data collected between December 2008 and November 2012, and a prospective study of patients followed-up for at least 6 months after the initiation of levodopa therapy. Ninety-one patients fulfilled criteria for clinical diagnosis of idiopathic Parkinson’s disease (58 males, mean age at onset 60.6 ± 11.3 years). Demographic data were compared to those of 2282 consecutive Italian patients recruited during the same period, whereas nested matched subgroups were used to compare clinical variables. Demographic features, frequency and severity of motor and non-motor symptoms were comparable between the two populations, with the only exception of more frequent tremor-dominant presentation in Ghana. At baseline, the proportion of Ghanaian patients with motor fluctuations and dyskinesias was 56% and 14%, respectively. Although levodopa therapy was introduced later in Ghana (mean disease duration 4.2 ± 2.8 versus 2.4 ± 2.1 years, P < 0.001), disease duration at the occurrence of motor fluctuations and dyskinesias was similar in the two populations. In multivariate analysis, disease duration and levodopa daily dose (mg/kg of body weight) were associated with motor complications, while the disease duration at the initiation of levodopa was not. Prospective follow-up for a mean of 2.6 ± 1.3 years of a subgroup of 21 patients who were drug-naïve at baseline [median disease duration 4.5 (interquartile range, 2.3–5) years] revealed that the median time to development of motor fluctuations and dyskinesias after initiation of levodopa therapy was 6 months. We conclude that motor fluctuations and dyskinesias are not associated with the duration of levodopa therapy, but rather with longer disease duration and higher levodopa daily dose. Hence, the practice to withhold levodopa therapy with the objective of delaying the occurrence of motor complications is not justified. Keywords: Parkinson’s disease, dyskinesias, levodopa, pathophysiology Go to:
  19. DaTscan results

    DAT tells you that you have a problem with the dopamine transporter and that there is some sort of parkinsonism but does not diagnose PD. A negative DAT scan can sometimes be misleading as there are now cases of negative scans in the big studies....converting to positive scans. Follow the symptoms and your medical team and be alert.....don't hesitate if needed to wait a year or two and repeat the DAT or have someone look at the actual original DAT (it could have been misinterpreted).
  20. Untreatable Dyskinesia

    Great questions. I would say that your best bet is an experienced movement disorders neurologist. Also our 18004PDINFO helpline nurses may help you as well. These are tough questions and hard to address. Following DBS if dyskinesia is troublesome you can halve either regular or extended release tabs (no problem). Using smaller and more frequent doses may help. GPi DBS may be better for dyskinesia compared to STN DBS. Amantadine may be helpful. Finally, the Duopa pump could be helpful even after DBS. Hope that helps....these are broad strokes thoughts....
  21. Young onset? Symptoms and strong family history.

    Sounds like possible PD given your symptoms and family history. I would get the actual DAT on a CD and bring for a second opinion. You could also repeat the DAT in the future. I would definitely look for a second opinion.
  22. Me Again. Q about Sinemet Adjustment

    This is one option. The other option for nausea is adding more carbidopa (lodosyn) or adding domperidone. To titrate the dose and interval of Sinemet is the best approach (then monitor symptoms). It takes time and partnership with your doc. Hope that helps.
  23. This definitely sounds like dyskinesia and as a first step we generally stop the entacapone in our clinic. We then adjust the dose and timing of SInemet. If there is dyskinesia after those two steps that is bothersome then amantadine could be helpful. Finally, DBS as the last option.....hope that helps.
  24. Help with questionable diagnosis

    It does sound like PD and yes the symptoms can fluctuate. Because you had nausea with the agonist I would normally at this point use regular Sinemet and titrate to a dose that will return your symptoms to normal or almost normal and facilitate working and also improving quality of life.
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