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Dr. Okun

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Everything posted by Dr. Okun

  1. Dr. Okun

    Reaction to Protein

    This is an effect that can occur in Parkinson....many experts believe it is the protein disrupting absorption of the meds but there may be more to it than that... We recommend giving your meds a 1/2 to 1 hour head start before eating (especially protein).
  2. Dr. Okun

    Ropinirole vs c-i levedopa

    Tough question. If there is room to maximize one drug without causing a side effect (e.g. impulse control disorder) then that route is appealing....
  3. Dr. Okun

    Neuroscience 2018 San Diego

    My pleasure.
  4. Dr. Okun

    Neupro patch on time

    Yes, you have to be careful. Also, in our practice we use plain sinemet and not agonists (in general) in the setting of dementia.
  5. Dr. Okun

    Steerable DBS

    There are no objective measures at this time however whether the lead is steerable or not is less important than if it is in general well placed. We use imaging (MRI-CT) plus thresholds at each contact to determine the location. Ask your doc about this approach.
  6. 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!
  7. 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.
  8. Dr. Okun

    Can An Initial PD Diagnosis Be Reversed?

    The best option is seeking a second opinion.
  9. 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.
  10. 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.
  11. 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.
  12. 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!
  13. Possibly add carbidopa or domperidone for nausea.
  14. 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.
  15. 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!
  16. 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.
  17. 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.
  18. 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.
  19. Dr. Okun


    I believe there is a generic.
  20. 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.
  21. Dr. Okun

    Las vegas is hopeless

    I am so sorry. Maybe our phone line with nurses can help 18004PDINFO.
  22. Dr. Okun

    What tests are done for Parkinson's disease?

    The best test is examination by an expert or qualified neurologist for several visits and a trial on PD medication. DAT scans are rarely needed and do not diagnose Parkinson's specifically.
  23. Dr. Okun


    I am not sure I understand the question or that there is data to suggest high temperatures cause PD patients to die more than the general population.
  24. Dr. Okun

    Sinemet and Tremor

    In some patients it may take anywhere between 0.5 tablets to 2.5-3 tablets per dose to capture or improve tremor and we like to have patients try the medications at a maximally tolerated dose for 8-12 weeks before declaring the tremor partially or completely refractory. We also check GI emptying if the tremor does not respond (meds may not absorb).
  25. Dr. Okun

    Nitrous oxide

    In general it is ok, but please work with your doctor to keep sedation as light as possible and not to use dopamine blocking drugs or nausea drugs that can lead to dopamine blocking (reglan, compazine, phenergan).