Prof Michael Okun: My Take
The Parkinson's Plate: A Health and Diet Guide to Manage Your Journey. Pre-order is now open for October 1st on Amazon. A practical, streamlined cookbook for living well with Parkinson's Disease. Many Parkinson's cookbooks overwhelm readers with dense science, restrictive diet rules, or an excess of complicated recipes. The Parkinson's Plate: A Health and Diet Guide to Manage Your Journey takes a different approach by delivering clear, focused guidance that respects the energy, time, and real-life needs of people living with Parkinson's and their caregivers. Co-authored by Dr. Michael Okun, and Emily Truscott, The Parkinson's Plate blends medical expertise with practical nutrition strategies that support daily function and quality of life. Designed as a companion book to Robert Rose's bestselling book, Living with Parkinson's Disease (2020, 2nd edition 2026). The recipes are simple, flexible, and designed for real kitchens. Concise, evidence-based, and highly usable, The Parkinson's Plate stands apart as a trusted, time-saving nutrition resource for people living with Parkinson's and those who care for them. Book Highlights: - Clear, concise explanation of Parkinson's disease and symptom management - Practical nutrition guidance focused on quality of life - Plain-language coverage of gut-brain health and diet-medication interactions - Research-based summaries of popular diets, including Mediterranean, MIND, vegetarian, ketogenic, gluten-free, and intermittent fasting - Easy, approachable recipes with minimal ingredients and preparation - High-calorie snacks and smoothies for weight and muscle support. https://cutt.ly/Jt2RlrzH
Can spinal manipulation prevent chronic low back pain? A new trial challenges some assumptions. Spoiler alert: What happens between visits may matter as much as what happens during a treatment session. Spinal manipulation refers to hands-on techniques used by chiropractors and physical therapists to improve joint movement and to reduce pain. Bronfort and colleagues describe in a new paper in JAMA Internal Medicine whether spinal manipulation and clinician-supported self-management can prevent acute low back pain from becoming a chronic disabling condition. Key points: - Clinician-supported biopsychosocial self-management was more effective than guideline-based medical care in reducing the long-term impact of low back pain. - Spinal manipulation alone did not outperform guideline-based medical care in preventing chronic impactful low back pain. - Adding spinal manipulation to self-management did not provide additional benefit beyond self-management alone. My take: This is an important study because it reminds us that chronic pain is rarely just about muscles, joints, or anatomy. The strongest signal in this trial came from helping folks build skills to manage pain, movement fears, stress, and daily function. The findings suggest that what happens between visits may matter as much as what happens during a treatment session. Also remember with chiropractic manipulation the low back is much safer than the neck because the neck area has the vertebral artery (imparts a small increased stroke risk). Here are 5 points that resonated w/ me: 1- Chronic low back pain is influenced by biological, psychological, and social factors, not just structural abnormalities. 2- Learning practical self-management skills may reduce the likelihood that an acute episode becomes a long-term disabling problem. 3- Fear of movement, low confidence, and pain 'catastrophizing' appear to be important treatment targets. 4- Spinal manipulation may help some individuals, however in this study it did not outperform standard medical care for preventing chronic impactful pain. 5- The future of back pain care may be less about finding a single treatment and more about empowering folks.
Why do some folks fail deep brain stimulation screening? Deep brain stimulation (DBS) candidacy screening refers to the process of determining whether the potential benefits of surgery outweigh the risks for a particular person. Patricia Graese and colleagues describe in a new paper in Movement Disorders Clinical Practice the largest multidisciplinary analysis to date examining why some folks with Parkinson's disease, essential tremor, and dystonia do not ultimately move forward with DBS surgery. Key points: - More than 1,700 patients underwent multidisciplinary DBS evaluation and 10.4% were ultimately denied or tabled for surgery. - Excessive cognitive risk was the most common reason for candidacy failure, accounting for more than 60% of cases. - Psychiatric concerns, unrealistic expectations, medical co-morbidities, diagnostic uncertainty, gait and balance issues, and swallowing concerns all contributed to screening failures. My take: This study highlights an important truth about DBS. Success begins long before the operating room. The multidisciplinary screening process is not designed to keep folks from receiving therapy. It is designed to identify who is most likely to benefit and who may be placed at unnecessary risk. One of the most important findings was that cognition emerged as the dominant factor influencing candidacy decisions. The data also reinforce the value of movement disorders neurologists, neuropsychologists, psychiatrists, rehabilitation specialists, and neurosurgeons all working together as a team. I am biased as an author so please make up your own mind. Here are 5 points that resonated w/ me: 1- Cognitive health remains one of the most important considerations when evaluating DBS candidacy. 2- Unrealistic expectations can be just as important as medical factors when determining whether surgery is appropriate. 3- Psychiatric symptoms should be identified and treated early because stabilization may reopen the door to future DBS consideration. 4- Multidisciplinary teams help uncover risks that may otherwise be missed and improve patient safety. 5- The goal of DBS screening is matching the therapy to the person.
The levodopa paradox: a medication, a biomarker, and a prognostic clue? Levodopa responsiveness refers to how much a person's parkinsonian symptoms improve when treated w/ levodopa; the most effective symptomatic therapy for Parkinson's disease. Arca and colleagues describe in a new paper in Annals of Neurology how levodopa responsiveness relates to diagnosis, prognosis, and underlying pathology across Parkinson's disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). Key points: - In pathology-confirmed Parkinson's disease, 86% of patients demonstrated a definite and sustained levodopa response, while 14% did not despite having PD pathology. - A definite levodopa response in PD was associated w/ a 55% lower risk of falls, a 69% lower risk of dementia, and a 69% improvement in survival. - Definite levodopa responsiveness showed excellent diagnostic accuracy in distinguishing PD from MSA and PSP, whereas acute levodopa challenge testing was considerably less informative. My take: This paper tackles one of the oldest questions in movement disorders: how much should we trust the levodopa response? The answer appears to be quite a lot, especially when the response is robust and sustained over years. What struck me most was that levodopa responsiveness was not simply a treatment effect. It carried important prognostic information. Folks w/ PD who enjoyed a durable response experienced fewer falls, less dementia, and lived longer. Equally interesting was that a small number of patients w/ MSA and PSP also responded, reminding us that biology is more nuanced than clinical stereotypes. The study reinforces why longitudinal observation still matters, even in an era of biomarkers and AI. Levodopa response definitely matters when choosing DBS candidates.
Ebola survivors may carry neurological scars for years after the infection is gone. Neurological sequelae are long-lasting brain, nerve, thinking, mood, sleep, or movement symptoms that persist after recovery from an illness. Bridgette Billioux and colleagues describe in a new paper in JAMA Neurology the neurological manifestations observed in adult survivors of Ebola virus disease followed for more than 7 years in Liberia. Key points: - Ebola survivors experienced a broad range of neurological symptoms including headaches, memory loss, depression, sleep disturbances, fatigue, tremor, sensory symptoms, and sexual dysfunction. - Neurological abnormalities involving cranial nerves, sensation, movement, coordination, and cognition were detected on detailed examinations performed by trained neurologists. - Most neurological symptoms improved over time, however memory loss, irritability, and trouble concentrating remained significantly more common in survivors more than 7 years after infection. My take: This study is a reminder that viruses can leave a lasting imprint on the brain and nervous system. Ebola is frequently viewed through the lens of survival from an acute infection, however the story does not end when the virus clears. The long-term neurological burden can affect quality of life, relationships, employment, and overall well-being for years. Here are 5 points that resonated w/ me: 1- The brain appears to be a major target of Ebola virus disease, and the neurological consequences can persist for many years. 2- Memory loss was one of the most common and durable symptoms, affecting more than half of survivors at long-term follow-up. 3- Sleep disturbances, depression, fatigue, and cognitive symptoms frequently traveled together, reinforcing the interconnected nature of brain health. 4- The encouraging news is that many neurological symptoms and examination findings improved over time, suggesting resilience and recovery are possible. 5- Survivors of major infectious diseases deserve long-term neurological follow-up and access to rehabilitation, mental health support, and cognitive care. https://jamanetwork.com/journals/jamaneurology/fullarticle/2850237 #ebola
Childhood brain development may be shaped more by neighborhood opportunity than IQ. Socioeconomics refers to the social and economic conditions in which a person lives, including factors such as neighborhood opportunity, income, education, housing, and access to resources. Marek, Dosenbach and colleagues describe in a new paper in Science how socioeconomic factors may be the strongest predictors of brain organization in childhood, even exceeding measures such as IQ and psychopathology. Key points: - Across 649 behavioral, environmental, and demographic variables, socioeconomic measures showed the strongest and most reproducible associations w/ brain structure and function. - The strongest single brain association was linked to neighborhood opportunity, and these patterns were concentrated in motor and sensory brain regions rather than classic higher-order cognitive networks. - Brain patterns associated w/ socioeconomic status closely mirrored patterns linked to sleep, stress, arousal, and norepinephrine signaling, suggesting that environmental factors may influence brain development through these pathways. My take: This is a provocative and potentially paradigm-shifting study. For years, many brain-wide association studies have focused on IQ, cognition, or psychiatric symptoms. Marek and colleagues argue that socioeconomic conditions may be the dominant signal shaping childhood brain organization. The findings suggest that what we frequently attribute to cognition may partly reflect the cumulative effects of sleep, stress, opportunity, and environment. If these observations hold up, then improving childhood environments may be one of the most powerful brain health interventions available. Here are 5 points that resonated w/ me: 1- Neighborhood opportunity showed stronger brain associations than IQ, psychopathology, or most other measured variables. 2- The affected brain regions were primarily motor and sensory networks, not the classic frontal and parietal regions typically linked to higher-order cognition. 3- Sleep and stress emerged as plausible biological pathways connecting socioeconomic conditions to brain development.
The UF and UCSF east-coast and west coast collaboration has been meeting in Colorado Springs to create impact for persons with Spinocerebellar Ataxia Type 6. Spoiler alert: adaptive DBS system! Thanks to the Raynor Cerebellar Project.
When tremor comes back after focused ultrasound: should you re-lesion or switch to DBS? Focused ultrasound thalamotomy creates a small lesion in a brain target involved in tremor control. Deep brain stimulation (DBS) uses an implanted electrode to deliver adjustable electrical stimulation to the same brain network. Nur Walker-Pizarro and colleagues describe in a new paper in Tremor and Other Hyperkinetic Movements how DBS can successfully rescue recurrent essential tremor following MRI-guided focused ultrasound thalamotomy. Key points: - Tremor recurrence after focused ultrasound does not necessarily mean the original procedure failed; it may reflect progression of a chronic neurological condition. - In this case, staged bilateral VIM DBS provided durable tremor control after tremor returned following an initially successful focused ultrasound procedure. - Therapeutic DBS stimulation was achieved even within a previously lesioned thalamic target, suggesting that focused ultrasound and DBS may complement one another over time. My take: This paper highlights an important reality. Essential tremor is a progressive disease, and no single intervention is likely to be the final chapter for every patient. Focused ultrasound and DBS should not be viewed as competing therapies. They may be different tools that can be deployed at different times in a person's journey. The ability to adjust DBS over time remains one of its greatest strengths, especially when symptoms evolve. I am biased as an author of this paper, so read for yourself and decide. Here are 5 points that resonated w/ me: 1- Tremor recurrence after focused ultrasound occurs in a subset of patients and should trigger a thoughtful reassessment rather than an automatic repeat procedure. 2- Essential tremor frequently progresses over time, and treatment plans should anticipate future needs. 3- DBS offers flexibility because stimulation can be adjusted as symptoms change. 4- Prior focused ultrasound does not necessarily prevent successful DBS therapy later in the disease course. 5- The future will likely be personalized, matching the right surgical approach to the right patient at the right stage of disease.
The Parkinson’s Plan is now available in Spanish. El plan para vivir con la enfermedad de Parkinson: Un nuevo enfoque para prevenirla y tratarla by RAY DORSEY, MICHAEL S. OKUN En esta obra, Ray Dorsey y Michael S. Okun, doctores y expertos en los últimos avances sobre la enfermedad de Parkinson, detallan los pasos necesarios para prevenir, ralentizar y tratar esta condición debilitante. Los autores exponen cómo prevenir la enfermedad a través de los alimentos que ingerimos, el agua que bebemos, el aire que respiramos y el estilo de vida que llevamos. Asimismo, nos presentan el Parkinson 25, la lista más detallada que existe para que cualquier persona pueda reducir el riesgo de padecerla. Los autores han entrevistado a los científicos, médicos y referentes en esta patología para ofrecer un plan detallado que incluye métodos innovadores y los más recientes avances médicos y tecnológicos. Una hoja de ruta con las estrategias necesarias para crear un mundo en el que esta enfermedad sea cada vez menos frecuente y los tratamientos más exitosos. https://cutt.ly/Xt2esco3
Can sitting too much change how you perceive your balance in Parkinson’s disease? Spoiler alert: Some folks underestimate their abilities and restrict activity, while others may overestimate their abilities and increase fall risk. Balance discordance refers to a mismatch between ‘how good’ folks think their balance is and ‘how good’ their balance actually is. Franziska Albrecht and colleagues describe in a new paper in npj Parkinson’s Disease how sedentary behavior may influence the effect of balance rehabilitation on balance discordance in Parkinson’s disease. Key points: - A highly challenging balance and gait training program improved balance performance however did not significantly change balance discordance across the entire study group. - Folks who were more sedentary before rehabilitation appeared more likely to improve the alignment between their perceived and actual balance abilities. - The findings suggest that physical rehabilitation alone may not be enough to recalibrate balance confidence and that psychological factors may also play an important role. My take: This paper reminds us that balance is not just about muscles and movement. It is also about perception. Some folks underestimate their abilities and restrict activity, while others may overestimate their abilities and increase fall risk. The future may require combining physical therapy, behavioral approaches and confidence building strategies to better align what the brain believes and what the body can do. Here are 5 points that resonated w/ me: 1- Parkinson’s disease can create a mismatch between actual balance ability and perceived balance confidence. 2- Simply improving physical performance may not automatically improve confidence or self-perception. 3- Sedentary individuals may have more room to recalibrate their understanding of their own abilities when exposed to challenging rehabilitation. 4- Fear of falling, anxiety and mood symptoms may influence balance confidence just as much as physical impairments. 5- The best rehabilitation programs of the future may target both the body and the brain by combining movement training w/ psychological strategies. https://www.nature.com/articles/
Can healthy eating prevent Parkinson's disease? A new 32-year study challenges assumptions. A dietary pattern is the overall way we eat, including combinations of foods such as fruits, vegetables, grains, dairy products and proteins rather than focusing on a single nutrient. Xiao Chen and colleagues describe in a new paper in Movement Disorders whether adherence to eight healthy dietary patterns influences the risk of developing Parkinson's disease. Key points: - Over 116,000 women and men were followed for up to 32 years and 1,179 participants developed Parkinson's disease. - Higher adherence to eight commonly recommended healthy dietary patterns, including Mediterranean, DASH, MIND and plant-based diets was NOT associated w/ a lower risk of Parkinson's disease. - Higher consumption of low-fat dairy products was associated w/ a higher risk of Parkinson's disease in this analysis. My take: This study is important because it is large, carefully performed and followed folks for more than three decades. The findings remind us that what is good for general health may not always translate into Parkinson's disease prevention. Healthy eating remains essential, however this study suggests we should be cautious about claiming that any specific dietary pattern prevents Parkinson's disease. The low-fat dairy signal is intriguing and deserves further study. Here are 5 points that resonated w/ me: 1- Healthy dietary patterns remain important because they lower the risk of many chronic diseases and support healthy aging. 2- Preventing Parkinson's disease is likely more complicated than following any single dietary strategy. 3- Environmental exposures, genetics and other biological factors may play a larger role in Parkinson's disease risk than previously appreciated. 4- The association between low-fat dairy intake and Parkinson's disease continues to appear across multiple studies and deserves closer investigation. 5- The future of Parkinson's prevention will likely require combining nutrition, environmental risk reduction, genetics and biomarker science into a more comprehensive strategy. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.70358
Can we measure Parkinson's disease progression years before diagnosis? An ‘alpha-synucleinopathy’ is a brain disease linked to abnormal accumulation of the protein alpha-synuclein and includes Parkinson's disease, dementia w/ Lewy bodies and multiple system atrophy. Monica Roascio and colleagues describe in a new paper in Brain how clinical changes in REM sleep behavior disorder (RBD) may be tracked years before the emergence of overt Parkinson's disease or dementia. Key points: - Using longitudinal data from 766 individuals w/ isolated REM sleep behavior disorder, the authors developed a model that tracks disease progression over time rather than relying on a single conversion event. - The model identified three markers reflecting earlier or later onset of progression, faster or slower progression, and whether motor or cognitive symptoms emerge first. - These progression markers were linked to established dopamine imaging biomarkers and to EEG measures of brain network dysfunction. My take: This study tackles one of the biggest challenges in neurodegeneration. We need better ways to measure progression before a person develops obvious Parkinson's disease or dementia. The traditional approach of waiting for ‘phenoconversion’ may miss many years of meaningful biological and clinical change. Continuous progression markers could ultimately improve clinical trials and help us identify who is worsening and when. Here are 5 points that resonated w/ me: 1- REM sleep behavior disorder remains one of the strongest known risk states for future Parkinson's disease and related disorders. 2- Motor changes appeared to worsen approximately 35% faster than cognitive changes in this cohort. 3- Clinical progression could be detected many years before traditional diagnostic milestones were reached. 4- Abnormal dopamine transporter imaging and abnormal EEG synchronization were linked to earlier and faster disease progression. 5- The future of disease-modifying trials may depend on continuous progression markers rather than waiting for a binary diagnosis of Parkinson's disease or dementia. https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awag193/8698219