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Dr. Okun

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Dr. Okun last won the day on October 4

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About Dr. Okun

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

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  1. Dr. Okun

    Neuroscience 2018 San Diego

    I am not aware of any new FDA approved treatments since the SFN conference but we constantly monitor the science and field. The science was excellent. The young patients like you in their forties were studied in the New England Journal and there was great benefit for DBS when motor fluctuations appeared (within 2 years).....it doesn't mean everyone should get DBS but it may be a good option. Moving your doses closer together and at some point eliminating comtan (back to regular sinemet) may help reduce dyskinesia. Apokyn we use for sudden offs and early mornings but in general is not the long term answer for what you describe. Hope that helps!
  2. Dr. Okun

    DBS surgery for other movement disorders

    This is a parkinson forum so we are not the best experts on this, but one option is seeking a university based or other comprehensive rehabilitation setting....another option is a clinical trial of medications or DBS. Cleveland clinic for example with Dr. Machado has a stroke DBS trial. Sorry we can't help more.
  3. Dr. Okun

    Can An Initial PD Diagnosis Be Reversed?

    The best option is seeking a second opinion.
  4. Dr. Okun

    Neupro patch on time

    This is a tricky question. Reduction in off time was in the setting of a controlled clinical trial. You are on both Stalevo and also a patch. You actually have many options. One option is to continue to increase the patch dose and try to improve on time. The other option is simply moving the Stalevo closer together. When you use an agonist (patch or oral) watch and monitor for impulse control issues (shopping, and others). Also, remember some symptoms may not respond to meds such as walking, talking and thinking.
  5. Dr. Okun


    Interesting and I love your analogy. In many of our DBS patients at night there may be wearing off of the dopamine and this can lead to dystonia and freezing. Ask your doc about extra sinemet doses to take each time you awaken at night as it may be re-emergence of symptoms.
  6. Dr. Okun

    What exactly can the DBS do?

    Here are my thoughts. The patient is the sun and we revolve around the patient. I believe always involve everyone but especially the patient in decisions. The DBS always works but the disease progresses and walking, talking and thinking become the main challenges in many cases. After 4-6 months there is not much utility in continuing detailed programming. Pick the best setting and monitor but focus on meds and therapies. The limits depend on the patient. I really hope you do well and I wish you well on the journey.
  7. Dr. Okun


    I agree with hypothalamus dysfunction but not sure PD patients die at high temperatures. I think however that PD patients are prone to dehydration in hot climates and can get orthostatic and fall.....good point!
  8. Possibly add carbidopa or domperidone for nausea.
  9. Dr. Okun


    I am so sorry this happened to you. Yes, hypomania can occur as a side effect or DBS or DBS surgery especially in people with a history or family history of bipolar or other similar disorders.
  10. Dr. Okun

    Punching in sleep

    Many patients will try a very low dose of a drug called clonazepam and get a sleep study and look at possible treatments. This is very common!
  11. Dr. Okun

    slowing progression of PD

    Thank you for the comment. The high intensity works for some but not all Parkinson and has not been shown to delay progression. I am so glad it is helping. Thanks for sharing.
  12. Dr. Okun

    Stutter Steps

    There are many causes of stutter steps and sometimes moving doses closer together to avoid wearing off and/or physical therapy will help.
  13. Dr. Okun

    Canabis and st. John Wort

    Thanks. Great information. St John's Wort can have some drug-drug interactions with blood thinners and other meds so be sure to inform your doctor. Great news.
  14. Dr. Okun


    I believe there is a generic.
  15. Dr. Okun

    Mucuna and Sinemet Together?

    It is usually not necessary as you can optimize one or the other to stay on one drug. But technically there is no problem mixing that I am aware of as long as the mucuna does not have other ingredients.