Michael Okun @MichaelOkun Twitter profile

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Michael Okun

11 months

A person with Parkinson's disease can't walk because of severe freezing but put him on a bike and he is fine. Great case by Snijders and @basbloem Love the explanation: 'This striking kinesia paradoxica may be explained by the bicycle's rotating pedals, which may act as an

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Michael Okun

@MichaelOkun

1 year

Do you know how to teach your patients (persons w/disease) the simple home maneuver; the Semont Plus to alleviate their dizziness from benign positional vertigo. If we all learn this technique and teach it, we will save the healthcare system a bundle. @JAMANeuro trial

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Michael Okun

@MichaelOkun

3 months

Rest in peace to the term, extrapyramidal system. @AbhiLenka11 and @JankovicJoseph put the final nail in the coffin in their new piece in @GreenJournal Neurology Clinical Practice. Key Points: - Johann Prus coined the term extrapyramidal in 1898. - He experimented on dogs and

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Michael Okun

@MichaelOkun

1 year

Hoover's neurological sign. Do you know how to perform it. We have been in neurology consults this week and we find this sign useful beyond organic from functional differentiation. Remember to utilize your contralateral hand under the ankle to help you gauge and understand the

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Michael Okun

@MichaelOkun

2 years

Why don't more people use Babinski Trunk-Thigh test (1897). We did it yesterday on rounds and med studs tred it to validate it actually works. 'Sit up w/arms crossed.' Watch the knees. If one or both stay down (even in paresis) start thinking functional.

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Michael Okun

@MichaelOkun

5 months

Big news with positive result announced for a randomized study of a GLP-1 agonist for Parkinson's just released @NEJM . A new era for Parkinson's or alternatively, more questions than answers raised by Meissner and colleagues. Key Points: - This multi-center French trial studied

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Michael Okun

@MichaelOkun

2 years

Do you know how to perform the 'Hoover' and 'Reverse Hoover' signs (1908 JAMA) at the bedside to differentiate organic vs. functional weakness? David Mendoza @UFNeuroRes helps us to demonstrate. This sign is used and 'misused' across all of medicine.

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Michael Okun

@MichaelOkun

4 years

Have you changed your slides to reflect the new image of Parkinson's disease by Armstrong et. al. in JAMA Neurology? Time to retire the Gower's sketch.

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Michael Okun

@MichaelOkun

1 year

Parkinson's disease? Think again. This guy was on valproic acid (Depakote) for 32 years and developed parkinsonism. It resolved a few months following discontinuation and replacement with an alternate drug.

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Michael Okun

@MichaelOkun

9 months

Is normal pressure hydrocephalus (NPH) over-diagnosed? YES. When appropriately diagnosed and treated can some symptoms improve w/ shunting. YES. Nice article by Akter and colleagues to help clinicians on their journey to sort this out. Key points: - NPH: think ventriculomegaly in

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Michael Okun

@MichaelOkun

9 months

Here is your humbling case of the day that was just published? ' Will you miss this 17 year old who comes in with a year and a half of behavioral change, loss of appetite, weight loss, and folks have suggested he has a functional movement disorder. Did you think PERM? Key Points:

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Michael Okun

@MichaelOkun

2 years

Teaser video for how to teach 'self treatment of BPPV' to your persons with dizziness. This is the recent positive randomized trial published in @JAMANeuro Check out article for full video. Self-treatment of Recurrent Benign Paroxysmal Positional Vertigo

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Michael Okun

@MichaelOkun

10 months

When you see a jaw tremor can you tell the difference between Parkinson and essential tremor? This example shows a Parkinson's chin/jaw tremor. Hint: look for the rest tremor in the arms. Key points for the clinician when assessing jaw/chin tremor: In PD commonly the mouth is

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Michael Okun

@MichaelOkun

11 months

What is the pathway in the brain most important to the essential tremor network? The cerebello-thalamo-cortical loop. What is the best review paper? @MarkHallett007 2018 @NEJM

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Michael Okun

@MichaelOkun

1 year

Do you know how to test all of the cranial nerves @NEJM ? There is a wonderful must read article for all trainees and also anyone who would like to brush up on their neurological examination skills. Here is a video teaser of the exam for cranial nerves III, IV and VI: Always

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Michael Okun

@MichaelOkun

8 months

Do you know the 7 new 'best practices' for relaying a diagnosis of dementia? Did you know previous standards did not take input from the person with disease or from the caregiver/care-partner? This is a super important issue and Melissa Armstrong @FixelInstitute and colleagues

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Michael Okun

@MichaelOkun

2 years

Levodopa was a miracle drug; when discovered literally woke up a generation of Parkinson's folks and freed some from asylum institutional care. Dyskinesias and on-off fluctuations, disease progression continue to challenge us. All young people should watch the movie Awakenings.

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Michael Okun

@MichaelOkun

2 years

Who doesn't have headaches? Can you differentiate hemicrania continua, cluster, paroxysmal hemicrania, SUNCT/SUNA? Can you name the pathways involved in these syndromes or their treatments? New Review @JAMANeuro Management Trigeminal Autonomic Cephalalgias

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Michael Okun

@MichaelOkun

1 year

Every person with #Parkinson should be counseled about the 'double risk' they have of developing a #Melanoma . This is preventable and we are doing a terrible job of 'continuous counseling' and educating in our clinics. We can also teach our persons with Parkinson how to

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Michael Okun

@MichaelOkun

6 months

Wow! New paper @NEJM showing that biomarkers are changing in Alzheimer's 6-18 years before clinical symptoms appear and a diagnosis is made. Key Points: - 648 participants and 648 controls. - Median follow-up was ~20 years and here is what the authors detected BEFORE SYMPTOMS

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Michael Okun

@MichaelOkun

10 months

Is this ALS or benign fasciculation syndrome (BFS). We get this consult quite a bit every year. This example in this video was a case of benign fasciculation syndrome limited to one muscle group. Key points: - Shocker fact on benign fasciculations is that some studies suggest up

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Michael Okun

@MichaelOkun

1 year

Do you know what the endotoxin hypothesis of #parkinsons is? 'Early microbiome changes and increased intestinal permeability elevate levels of lipopolysaccharide (LPS) in the gut wall. Promotes local inflammation, induces α-synuclein expression and aggregation locally in the gut,

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Michael Okun

@MichaelOkun

1 year

Would you know myorhythmia if you saw it? Would you think paraneoplastic? Myorhythmia is so seldomly seen this is a great opportunity to share. Here are some adjectives to keep in mind: repetitive, rhythmic, slow (1-4 Hz). Locations: tend to be cranial and limb. This cool case by

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Michael Okun

@MichaelOkun

2 years

Stop using MoCA/MMSE total scores to characterize cognitive dysfunction? I prefer bedside tests of frontal function, memory, language, praxis, parietal and visual-spatial; then consider other features. Total numbers helpful in research; less important in solving mystery. Agree?

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Michael Okun

@MichaelOkun

7 months

Does diet affect Parkinson's symptoms? You bet it does. Do you know what 'nutritional over-reach' is? Do you know the differences between: Mediterranean (MeDi), Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), Alternative Healthy Eating Index (AHEI),

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Michael Okun

@MichaelOkun

19 days

New review paper just out today @NEJM on Parkinson's disease by Professors @JillOstremUCSF and Carlie Tanner @UCSFHospitals . Check out the gems they include like this chart of all the current medication options. I added the 'hot' new article sign as we presented in Aspen

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Michael Okun

@MichaelOkun

1 year

When I say 'see saw nystagmus' you say 'suprasellar' mass or lesion.

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Michael Okun

@MichaelOkun

1 year

Do you know what Parkinson subtype you are? I put together a collage of possibilities. The biggest problem with these classifications is they all may shift from one subtype to another over time. Will AI solve this? The new biological definitions proposed for PD and

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Michael Okun

@MichaelOkun

9 months

Do you know differences between catalepsy versus waxy flexibility which may occur together as signs of catatonia? Two of the coolest and most mysterious signs which may be associated with catatonia. Catalepsy think muscular rigidity and fixity of posture; you may give external

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Michael Okun

@MichaelOkun

8 months

Do you know what 'Alice in Wonderland' syndrome is? It is a perceptual disorder w/ distortions of visual perception, metamorphopsias, misperceptions of body schema and distortions in the experience of time. Blom reviews the medical literature on this somewhat neglected syndrome

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Michael Okun

@MichaelOkun

10 months

Do you know all the Parkinson's disease gait related compensation strategies folks have employed successfully? @Bloem and colleagues nail it. I am sure there are more, however no better review video than this one. 1- Counting 2- Skating 3- Sliding sideways 4- Running 5- Cycling

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Michael Okun

@MichaelOkun

10 months

Can you identify diphasic dyskinesia in Parkinson's disease? Great teaching video. Hint: watch rapid improvement of dyskinesia with fast-acting apomorphine. Dyskinesia tips for the clinician: associated with higher per dose levodopa, greater disease severity and longer disease

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Michael Okun

@MichaelOkun

3 months

Nice cool picture on the ‘biology’ of Parkinson's @ParkinsonismD . When a threshold of neuronal loss is passed, the clinical phase of PD manifests, w/ the motor and non-motor features. Interesting visual summary, though we are uncertain on a few steps.

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Michael Okun

@MichaelOkun

18 days

Want a comprehensive table summarizing the treatment of non-motor Parkinson's symptoms, look no further than this article just out @NEJM by Tanner and @JillOstremUCSF . #Parkinsons

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Michael Okun

@MichaelOkun

6 months

Do you know all the recent updates on Parkinson disease psychosis? From phenomenology to neurobiological mechanisms? From hallucinations, to illusions to delusions. Mechanisms, brain imaging, brain chemicals, treatments and beyond are reviewed by Pagonabarraga and Kulisevsky

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Michael Okun

@MichaelOkun

2 years

Do you know the proper way to perform Kernig and Brudzinki signs? 4th year ⁦ @UFMedicine ⁩ stud Tyler Goldman helps us by demonstrating and filling in the history. We were consulted for stiff neck, ‘meningismus.’ ⁦ @FixelInstitute ⁩ ⁦⁦ @NMatch2023 ⁩

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Michael Okun

@MichaelOkun

1 year

Do you know what 'Oculomasticatory Myorhythmia' looks like? Check out this video; does it blow your mind if I tell you it was caused by an infectious disease and TREATABLE if you pick it up. A classic case published by John Selhorst MD from Saint Louis University. A

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Michael Okun

@MichaelOkun

1 year

Mind blowing MRI: Bilateral basal ganglia lesions from methamphetamine, the 'lentiform fork sign;' Think uremic encephalopathy, metabolic acidosis, intoxications, methanol, genetic acidopathies. atypical posterior reversible encephalopathy.

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Michael Okun

@MichaelOkun

7 months

Can you name the 'Big 4' Brain Networks implicated in depression? I am biased however, I think @karaannjohnson 's figure is the best one I have ever seen on the topic. Also, if you are going to stick electrodes in the brain for depression probably a good idea to be aware of the

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Michael Okun

@MichaelOkun

1 year

Use all the clues available to decide whether or not someone has NPH. Love this picture of the atrophy pattern which may be a clue. The most critical aspect of management of potential NPH is to be thoughtful, use all the data, think about levodopa challenge if appropriate, and

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Michael Okun

@MichaelOkun

2 years

Americans love using this neuro exam finding. 'The examiner holds the slightly bent fingers and then snaps the nail of one of these fingers.' Johann Hoffmann NEVER published which frustrated Americans. Published in 1911 by his student Hans Curschmann (1875-1950). 'Hoffmann sign.'

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Michael Okun

@MichaelOkun

11 months

Ataxia w/ Vitamin E deficiency. Unique dystonic head tremor with bilateral postural hand tremor. The head tremor: irregular, jerky pattern with variable amplitude. Geste: turning the head touching the lower face.

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Michael Okun

@MichaelOkun

9 months

Is Parkinson's much more environment than genetics and other factors? Bogers, Bloem and Den Heijer lower the boom by publishing this hypothesis and challenging our conventional thinking. Thoughts? Key points: - Parkinson’s disease is now the most rapidly growing

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Michael Okun

@MichaelOkun

1 year

Do you know the 4 vitamin deficiencies to think about when you encounter ataxia (clumsy gait). Thanks @MarkHallett007 for a brilliant ataxia talk @movedisorder Aspen.

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Michael Okun

@MichaelOkun

1 year

Do you know the latest in Wilson's disease? New Review! I have been waiting for @NEJM or another major journal to take this topic on for over a decade. Well, they delivered; Roberts and Schilsky teach us 'how many body systems can be affected,' in this treatable disease that

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Michael Okun

@MichaelOkun

9 months

Can you name all the features associated with catatonia and the current diagnostic criteria. I bet you that most of you cannot and will need to read the new review in @NEJM which rightly points out that catatonia has been 'well described but is poorly understood and that many

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Michael Okun

@MichaelOkun

1 year

What neurological disease is associated with drinking large quantities of low quality wine? Hint: think corpus callosum. Marchiafava–Bignami Disease. Guess what folks it is actually more associated with malnutrition as this newly published case shows as this 61 year old was not a

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Michael Okun

@MichaelOkun

3 months

Mahlon DeLong (1938-2024) was the GOAT in his long-running career as a combined neurologist and neuroscientist. He took great care of the world's GOAT (Ali), however this is one title (GOAT neurologist-neuroscientist) that belongs to him, and him alone. It is with a heavy heart

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Michael Okun

@MichaelOkun

2 years

'Tic Status' is different than epileptic status. 'Continual motor tics non-suppressible, intrude into normal functioning.' -Sachdev 1996 Cases reported included neuroleptic and now DBS withdrawal. However this case has 'functional' feel to me. Thoughts?

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Michael Okun

@MichaelOkun

2 years

Ismail uses an Instagram filter to track tremor. Cool idea even if not ready for prime time from Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait. @theneurolander @OGdukeneurosurg

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Michael Okun

@MichaelOkun

8 months

Have we been ignoring the possibility of multiple pathologies in the brain accompanying Parkinson's? You bet we have. Walker and Attems in a new paper in @journal_PD review the topic and shine some light on this important area. Key points: - Pathologies including #Alzheimers ,

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Michael Okun

@MichaelOkun

7 months

Do you have an approach to starting and maintaining medication cocktails for Parkinson's? Beautiful paper by @foltynie @ajlees and colleagues @TheLancet which offers a practical approach to medications, multidisciplinary care and also addresses the surgical and physical

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Michael Okun

@MichaelOkun

11 months

Can infection cause parkinsonism? Yes. Check out the substantia nigra in a case of West Nile virus encephalitis is one of many examples.

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Michael Okun

@MichaelOkun

2 years

The Babinski Trunk Thigh Test. Try it like #ufmedicine @UFHealth student Niran Vijay did for us on rounds. It takes voluntary effort to keep your knees or even a single knee down and ‘not to flex’; great to tell functional ‘knee down’ vs organic paralysis/weakness: ‘knee up’.

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Michael Okun

@MichaelOkun

1 year

How important is the finger tap to the Parkinson and movement disorders examination. This is such a critical part of the examination and there are so many aspects you must pay attention to. The @movedisorder Aspen 2023 faculty demonstrating it's importance at the course. A

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Michael Okun

@MichaelOkun

10 months

What ataxia diagnosis are we 'missing' all the time?Cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS); adult-onset, slowly progressive neurodegenerative condition; cerebellar ataxia, sensory neuronopathy, and bilateral vestibulopathy; possible dysautonomia.

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Michael Okun

@MichaelOkun

9 months

Can you name the 5 alien limb syndromes? This video shows one of the most famous: inter-manual conflict. Key points: - Did you know it is important to localize where the pathology is likely within the brain and whether you have a disconnection syndrome; anterior vs. posterior and

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Michael Okun

@MichaelOkun

10 months

Humbling to think that over the past decade, collective evidence keeps dripping and providing clinical, pathological, neurophysiological, structural and functional neuroimaging findings showing a link between the cerebellum and PD. New review!

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Michael Okun

@MichaelOkun

9 months

Do you keep reading about the 'typecasted' substantia nigra and Parkinson's? What is this mysterious place in the brain that is so important to this syndrome. Really amazing teaching video on youtube from 2-minute neuroscience. Also reviewed in Stat Pearls by Sonne. Key points: -

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Michael Okun

@MichaelOkun

2 years

Cool thought of the day. Music modulates brain networks and physiology. Mind blowing to think that brain physiology and networks change whether you listen to Taylor Swift, Tupac, Neil Diamond, Coldplay or Mozart. Read this review in @Nature

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Michael Okun

@MichaelOkun

2 years

I would challenge #NeuroTwitter community to find a more beautiful textbook picture of the 'Babinki sign.' I found this in my 1929 Bing's compendium and it came with a robust discussion of the sign and alternative ways to elicit it. Happy Friday! @theneurolander @OGdukeneurosurg

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Michael Okun

@MichaelOkun

5 months

Check out the unusual gait pattern worsened by levodopa in this case of a PARKIN gene related Parkinson's. This is why we call it Parkinson's diseases plural as there are so many different manifestations, with or without known gene mutations. Nice case by Mehta and colleagues in

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Michael Okun

@MichaelOkun

10 months

Will you recognize and test for paradoxical kinesia in Parkinson's disease? Remember the movie #awakenings ? One hypothesis is that presentation of external sensory cues triggers a significant increase in motor velocity. Another hypothesis is that an internal cue in the absence of

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Michael Okun

@MichaelOkun

1 month

While everyone else is speculating, BRAVO to @TIME magazine for writing this excellent piece on how Parkinson's disease is diagnosed. It is a great 6 minute read which reminds us that Parkinson’s disease might be better called Parkinson’s diseases—plural—because the condition has

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Michael Okun

@MichaelOkun

5 months

Does exercise slow Parkinson's disease progression?Check out what happened to the dopamine transporter levels pre- and post 6 month intense exercise. Thanks @lvolpic for sharing this study from de Laat and colleagues in @Nature_NPJ @Nature Key Points: - The authors employed

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Michael Okun

@MichaelOkun

7 months

Is Parkinson's disease predominantly an environmental disease? Are you thinking about this as ab ovo usque ad mala – from the egg to the apples, a story from the beginning to the end? Check out this debate piece by @RayDorseyNeuro @basbloem @journal_PD Key points: - Parkinson’s

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Michael Okun

@MichaelOkun

2 years

Huge Alzheimer’s news; new drug! Phase 3 confirmatory Clarity AD clinical trial of lecanemab, investigational anti-amyloid beta (Aβ) protofibril antibody, met primary endpoint (CDR-SB: Clinical Dementia Rating-Sum of Boxes) and key secondary endpoints. Great news! @FixelInstitute

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Michael Okun

@MichaelOkun

9 months

What do residents forget on their neurological examination of neurodegenerative diseases? They are thinking brain and forget to look at the first dorsal interosseous muscle for atrophy and fasciculations? This example turned out to be ALS. Key Points: - It is not only ALS that

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Michael Okun

@MichaelOkun

23 days

A new blood test approach to screen for Alzheimer's was just published in JAMA. Would you sign up for affordable blood tests for Alzheimer's or down the road Parkinson's which may be offered by general doctors and advanced practice providers? Will these be game changers for care

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Michael Okun

@MichaelOkun

11 months

Do you know the differential diagnosis for oculogyric crisis? 'Looking up syndrome.' Think of seizures, paroxysmal tonic upgaze in kids, ocular dyskinesia like in Parkinson's from levodopa, ocular tics, and functional movement disorder. The most common cause is medication

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Michael Okun

@MichaelOkun

8 months

Do you look at the corpus callosum when sorting out a neurological diagnosis. Many folks don't and the answer may be right in front of your eyes as Xie and Sun teach us @JAMANeuro Key points: - In this case progressive memory loss and left limb numbness. - Misdiagnosed as a

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Michael Okun

@MichaelOkun

26 days

What causes the placebo effect? What are the neural circuits underpinning the placebo pain? What's the pons got to do with it? Chong Chen, Grégory Scherrer and colleagues hit it out of the park with their new paper @Nature . Key Points: - The authors remind us that the placebo

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Michael Okun

@MichaelOkun

23 days

Is spasticity a result of lesions of the pyramidal tract (corticospinal tract)? Nope as @MarkHallett007 clarifies in an elegant physiology talk for us today. If you thought this spasticity = CST, you are not alone, as this is a common misperception, and alyhough it may be

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Michael Okun

@MichaelOkun

1 year

Catatonia: can you recognize it? Great video and discussion on terminology and how psychiatrists and neurologists do not always clearly communicate. Dystonia, waxy flexibility, treat with benzos. The experts @movedisorder agreed we need to rethink this d/o.

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Michael Okun

@MichaelOkun

5 months

Are caffeine metabolites from the coffee you are drinking protective against a later diagnosis of Parkinson's? Key Points: - Boom! These authors quantified biomarkers of caffeine intake years before Parkinson's onset. - They used associations between self-reported total coffee

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Michael Okun

@MichaelOkun

1 month

How cool is it to appreciate that Alice in Wonderland Syndrome maps to a common brain network linking body and size perception? Friedrich, @foxmdphd and colleagues really ‘nail’ this syndrome down in their new imaging paper which appeared in the Annals of Neurology @TheNewANA1 .

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Michael Okun

@MichaelOkun

9 months

How small are the targets we aim at for deep brain stimulation and lesion therapy for #Parkinsons , movement and neuropsychiatric disorders? I describe them to students as 'miniscule.' Great new paper by @jlchan and @JWongggMD @FixelInstitute which shows the comparison of the

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Michael Okun

@MichaelOkun

17 days

Can you name primary, secondary and tertiatry prevention strategies for Parkinson's disease? Caitlin Agarwal in @NEJM was the artist for this supplementary figure which is a gem and you should not miss reading and digesting it, as it is hidden in the supplementary information.

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Michael Okun

@MichaelOkun

11 months

Would you know a juvenile Gerstmann-Sträussler-Scheinker disease (GSS) person if you encountered one? It is a rare genetic prionopathy caused by pathogenic variations in the prion-related protein gene (PRNP). Key features: Progressive cerebellar ataxia Pyramidal signs Dementia.

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Michael Okun

@MichaelOkun

1 month

Do you know the differences between MoCA vs. mini-mental status examinations vs.multi-hour neuropsychological testing? Drs Fred Cohen, Shiv Sudhakar and I sat down @FoxNews as a chance to educate the public. Folks remember the Goldwater rule as this is about education and not

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Michael Okun

@MichaelOkun

17 days

Many experts think diagnosing functional dystonia to be the trickiest of all movement disorders. Thanks Professor @AlbertoEspay

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Michael Okun

@MichaelOkun

5 months

Have you stopped to think why there may be a link between Alzheimer's and epilepsy? Kamond and colleagues wrote an intriguing review in @Nature Reviews Neurology. Key Points: - Brain cell hyperexcitability in Alzheimer disease 2-3X higher. - Could late-onset epilepsy might be a

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Michael Okun

@MichaelOkun

7 months

Have you heard of the HALO effect on substantia nigra MRI imaging? What disease comes to mind? Look at the hyperintensity (brightness) of the substantia nigra and cerebral peduncles with a central band of hypointensity (darkness) usually seen on T1 MRI. This is caused by

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Michael Okun

@MichaelOkun

1 month

Looking for a master class in essential tremor and essential tremor versus Parkinson's disease? Look no further as Binit Shah and Jeff Elias @UVA have a new piece in JAMA Insights. Key Points: - ET is frequently diagnosed in primary care settings based only history and

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Michael Okun

@MichaelOkun

7 months

Did you know that in PSP there is more to the facial expression than the 'stone face?' Did you know there may may associated 'cogwheeling' in the eyes? Did you know the first description was from a neurology resident in training? Peter Lewitt reminds us of the hidden gems in old

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Michael Okun

@MichaelOkun

8 months

Can you identify 'belly dancer's dyskinesia?' How about we show you a case due to status epilepticus? Amazing video and EEG was documented by Hurtado-Bedoya and colleagues @GreenJournal Key points: - Involuntary rhythmic contractions of the left side of his abdomen. - This

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Michael Okun

@MichaelOkun

1 year

Deep Brain Stimulation to treat stroke. Andre Machado and Ken Baker and colleagues @ClevelandClinic in a new @NatureMedicine paper showed dentate nucleus stimulation was effective for a small pilot cohort of folks. Who were they? 'Individuals with a first-time, unilateral,

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Michael Okun

@MichaelOkun

11 months

The oldest surviving film of patients w/ Parkinson's disease from Romania. This film later taken by Belgian anatomist and neurologist Arthur Van Gehuchten at the beginning 20th century recognized potential of cinematography in neurological diseases.

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Michael Okun

@MichaelOkun

10 months

Do you train your eyes to look for asymmetric atrophy on MRI in case a corticobasal syndrome is hiding? Most radiologists just comment 'atrophy,' and this is another reason to always read your own scans. Does it match the clinical picture?

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Michael Okun

@MichaelOkun

9 months

Can a person have an alien leg? YES. Limb levitation in corticobasal syndrome is something we see commonly in an expert clinic. This video and report shows involuntary movements of the right leg “alien leg”. In order for the patient to stand up the doctor had to stand on his

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Michael Okun

@MichaelOkun

10 months

Higher risk of Parkinson's if you have bipolar disorder. This is a MUST READ new review on bipolar disorder in @JAMA_current by Nierenberg and colleagues.

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Michael Okun

@MichaelOkun

8 months

Do you know the ‘Pants-Sign’ as a predictor for falling in Parkinson’s? Jansen and colleagues add a nice tip both for clinicians and folks w/ #Parkinsons @journal_PD Key points: - A history of falls is the most 'established predictor' of future falls in PD. - Difficulties

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Michael Okun

@MichaelOkun

1 year

Braak vs. Borghammer? Battle of the #parkinsons pathologists. Where do you stand? Do you like Braak staging, Body vs. Brain First, Neither, Hybrid or other theory on Parkinson's pathogenesis?

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Michael Okun

@MichaelOkun

2 years

Do you have a bedside neuro test for 'functional hemi-anaesthesia?' With an assist from our pediatric neurology resident @UFNeuroRes Dr. Singh we share the 'child's play' NEJM 1963 sign Bowlus and Currier. Challenge: Hard keep hands together/cooperation!

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Michael Okun

@MichaelOkun

9 months

What did the newest large antibody trials for Alzheimer's disease just published @NEJM reveal? There were two large phase 3 trials of Gantenerumab for early Alzheimer’s. Survey says: NEGATIVE, did not meet primary outcome variable. Let's discuss and think about WHY? Key points:

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Michael Okun

@MichaelOkun

1 year

Will you recognize progressive ataxia and palatal tremor (PAPT) syndrome? Whenever palatal tremor always think medulla and brainstem. Quick what is your differential? Anti-NMDA encephalitis, Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to

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Michael Okun

@MichaelOkun

1 year

No one ever presents to their doc or advanced practice provider and states "I have trouble with my finger taps." @AlbertoEspay kicks off @movedisorder Aspen course today with an overview of phenomenology of movement and makes the clear point we need to look for 'bradykinesia'

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Michael Okun

@MichaelOkun

3 months

Do you know what is under the umbrella of anti-GQ1b antibody syndrome? Hint: It may be beyond the reverse 'eye first' Guillain-Barré syndrome we call Miller Fisher. Great review article @JAMANeuro with a great summary figure and discussion. Key Points: - Anti-GQ1b antibody

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