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Dr. Okun

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Dr. Okun last won the day on October 4 2018

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About Dr. Okun

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    Advanced Member

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  • Location
    University of Florida
  • Interests
    Parkinson disease and movement disorders

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  1. Dr. Okun


    Thank you.
  2. The DAT only tells you there is an abnormality in the dopamine transporter. It usually indicates some type of disorder which may or may not be Parkinson, but certainly involves dopamine. We rarely need this test for diagnosis.
  3. Thanks Tom for the question. We also have a helpline at 18004PDINFO.
  4. Interesting. Not a lot of data on this for Parkinson's.
  5. It's a little early to have syncope in the first 3 years, but could also be meds. Sometimes the doses are too high and you may need lower doses more frequently. Also hydration, stockings and medication (florinef, midodrine or droxidopa) may be helpful....
  6. Could be the metoclopramide and stopping it can help. Sometimes it takes weeks or more to wear off. You may want to try ondansatron for nausea which won't worsen PD. Also your neurologist may be able to change dose of Sinemet and also increase frequency to try to better control symptoms (temporarily).
  7. Lewy Body Dementia is a formal diagnosis of a parkinsonism that begins in the first few years with cognitive changes and psychosis. Psychosis can occur in Lewy Body Dementia or in regular Parkinson's disease. It usually occurs later in Parkinson's disease. Interestingly the pathological changes in the actual brain are similar with deposition of a protein called alpha synuclein (a Lewy Body).
  8. The dopamine agonists are thought to work by stimulating certain dopamine receptors in the brain and basically changing the threshold for impulsivity (abnormal behaviors). They put people at risk of these behaviors who may have otherwise been normal. This happens in 15-20% of PD patients on agonists.
  9. Dr. Okun


    I like to work with the family to get the psychosis under control as soon as possible but also use a counselor or licensed clinical social worker to work with the family.
  10. Dr. Okun


    The question is do they ever retain insight. The answer is YES, sometimes insight is retained. In many cases it is not....
  11. Thanks for the question. It is LRRK2 mutation I think (the one you may mean to ask about). I do not know the genetics well enough to address the idea that it would disappear from the gene pool. I suspect that it depends highly on your genetics and your partner's genetics. This would be a great question for a genetic counselor. I always recommend people see a genetic counselor. After counseling many people decide against testing.
  12. Dr. Okun


    We usually check a urinalysis, and then simply the regimen to Sinemet (or Madopar) only. We find the right dose and frequency of administration and then if still hallucinating we use either seroquel, clozapine or pimavanserin.
  13. Dr. Okun


    We have written an article about this that is about to come out soon. Basically it is best to have a full interdisciplinary workup. Then the team should take about risks and benefits and plan approach (unilateral or bilateral) and whether to do it all in one surgery or stage it. The final thing the team should do is review the FDA approval for the brain target selected and approach and then once all of the above is done choose the device that is best. In general the rule is that all the devices work great if implanted in the right spot in the brain. That is far and away the most important factor. Some patients like the idea of recharging every few days and others would prefer a simple surgery every 3-5 years.
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