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Michael S Okun, MD

@michaelokun

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Neurologist, Author of The Parkinson's Plan, Professor, Neuroscientist, Medical Advisor for the Parkinson's Foundation, and Director UF Fixel

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RIP Ozzy Osbourne (1948 – 2025). As a global rock icon, Ozzy inspired millions with his music, but even more profoundly, he moved the Parkinson’s community by bravely sharing his diagnosis and becoming a pioneer in the conversation around advanced therapies, including stem cell treatments. His transparency gave hope to countless individuals and families navigating this challenging journey. I am grateful for his courage, candor and commitment to progress in Parkinson’s research. We honored his story and explained the type of Parkinson's he had (PARKIN gene) in the publication The Conversation which can be read at: https://theconversation.com/ozzy-osbourne-has-a-type-of-parkinsons-disease-called-parkin-a-neurologist-explains-130367. Thank you Ozzy, you made a huge difference in the lives of many people. #michaelokun #fixelinstitute #parkinson #stemcell #ozzyosbourne #ozzy by @michaelokun

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Our book is now taking pre-orders and it is a great holiday gift to look forward to. The Parkinson’s Plan, two doctors detail the steps necessary to prevent, slow, and treat this debilitating condition. They show readers how to prevent the disease through the food we eat, the water we drink, the air we breathe, and the lifestyles we live. They introduce the “Parkinson’s 25,” the most detailed checklist ever created to allow anyone to lower their risk of Parkinson’s. They interview the world’s top scientists, clinicians, and thought leaders in the Parkinson’s field to offer a detailed plan for treatment that includes cutting-edge methods and recent technological and medical advances.
https://www.hachettebookgroup.com/titles/ray-dorsey-md/the-parkinsons-plan/9781541705388/ #parkinson #michaelokun #fixelinstitute by @michaelokun

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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 many different causes and expressions. No doctor of any kind, of course, can diagnose Parkinson’s in someone without seeing and evaluating the person. When it comes to the President or any other public official or celebrity, Okun abides by the so-called Goldwater Rule—adopted by the American Psychiatric Association after hundreds of psychiatrists presumed, without an exam, to diagnose mental illness in Republican presidential nominee Barry Goldwater in 1964.
Thank you to @jeffreykluger for putting the focus back on bringing awareness to the fastest growing neurodegenerative disease on the planet. https://time.com/6996568/parkinsons-disease-diagnosis-explainer/ #Parkinsons #michaelokun #time #FixelInstitute by @michaelokun

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What should every person with Parkinson's disease have in their kitchen? In this short video, I share five building blocks for a Parkinson's-friendly kitchen, including nutrient-rich foods such as berries, leafy greens and beans. As a neurologist, I frequently remind folks that nutrition is an important part of living well with Parkinson's disease. The foods we choose can support brain health, gut health, energy and overall well-being. There is no single food or diet proven to stop Parkinson's progression, but small, practical changes in what we eat can make a meaningful difference in our daily health. The goal is not perfection. It is building a healthier kitchen, one food at a time.
https://youtube.com/shorts/x3bqknKjX5I?feature=share by @michaelokun

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Regardless of the diet or eating approach you follow, some nutritional building blocks remain important. In The Parkinson’s Plate, five key groups take centre stage: berries, leafy greens, beans, nuts and seeds, and olive oil.
Together, they bring variety, fiber, healthy fats, protein, vitamins and minerals to the plate, while helping create meals that are wholesome, colourful and balanced.
Think colour, variety and balance, not rigid rules. 🌈
Discover The Parkinson’s Plate for more practical guidance on nutrition and eating well with Parkinson’s.
Get your copy online or from a bookstore near you! 📚
[Parkinson’s nutrition, Parkinson’s diet, balanced diet, whole foods, berries, beans, leafy greens, nuts and seeds, olive oil, Mediterranean diet, Parkinson’s Plate]
#TheParkinsonsPlate #ParkinsonsNutrition #ParkinsonsDiet #HealthyEating #RobertRoseBooks by @michaelokun

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Folks w/ GBA1 Parkinson's should NOT automatically be excluded from DBS! GBA1 is a gene associated w/ an increased risk of Parkinson's disease and a greater likelihood of cognitive decline. Deep brain stimulation is a surgical treatment that uses electrical stimulation to improve movement symptoms. Evridiki Asimakidou and colleagues describe in a new paper in Movement Disorders how the timing of DBS may influence cognitive trajectories in folks w/ GBA1-associated Parkinson's disease.
Key points:
- This multicenter study included 343 folks w/ Parkinson's disease who underwent subthalamic nucleus (STN) DBS, including 91 GBA1 carriers and 252 non-carriers.
- Folks w/ GBA1 Parkinson's who underwent DBS later in their disease course experienced significantly faster cognitive decline than those receiving DBS earlier. The strongest differences emerged around the 7- to 8-year disease duration thresholds.
- Cognitive decline was greater overall in GBA1 carriers compared to nocarriers, however the severity of the GBA1 genetic variant did not clearly predict the cognitive trajectory.
My take: This study addresses an important clinical dilemma. Should we deny a potentially life-changing therapy to someone simply because they carry a GBA1 variant and may be at greater risk for cognitive decline? I would argue absolutely not. We must have thoughtful and transparent discussions about cognitive trajectories, including the possibility of worsening memory and thinking over time. However, an increased risk of cognitive decline does not automatically mean someone should be excluded from DBS. We should be discussing motor benefits, current cognitive function, quality of life, disease duration, individual goals and the potential window of opportunity for treatment. Importantly, this observational study does not prove that earlier DBS prevents cognitive decline or that DBS itself causes the decline. by @michaelokun

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by @michaelokun

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What sticks with me about this fascinating case of adult-onset bobble-head doll syndrome is how a rare and potentially reversible neurological condition can masquerade as a more familiar movement disorder. Shibayama and colleagues describe a 24 year old man who had been working and living independently but developed progressive memory loss, urinary incontinence, severe gait instability, and unusual side-to-side no-no head movements. The paper appears in the journal Tremor and Other Hyperkinetic Disorders. His cognitive testing was striking, with a Montreal Cognitive Assessment score of only 12 out of 30. Even more fascinating was that touching his face temporarily stopped the head movements, a sensory trick we commonly associate with cervical dystonia. Brain MRI revealed massive enlargement of the ventricles caused by a thin membrane, or aqueductal web, blocking the normal flow of cerebrospinal fluid. Following ventriculoperitoneal shunt surgery, his head movements completely disappeared within one week, and his walking, cognition, and bladder control gradually improved. At 18 months, he was independent in daily activities, although mild memory difficulties persisted and he had not returned to work. The differential diagnosis of unusual head movements should include cervical dystonia and dystonic tremor, essential tremor, cerebellar tremor, functional movement disorders, and less commonly tics or other structural brain disorders. When head bobbing is accompanied by cognitive decline, gait dysfunction, or urinary symptoms, we should particularly consider hydrocephalus, including obstruction from aqueductal stenosis or webs, third ventricular cysts, and tumors. Treatment depends on the cause: botulinum toxin injections for cervical dystonia, selected medications for essential tremor, and neurosurgical treatment for obstructive hydrocephalus, including endoscopic third ventriculostomy or shunting. In this case, the anatomy made shunting the safer choice, although a postoperative subdural hematoma required valve adjustment and monitoring. by @michaelokun

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Can we restore sight by turning nerve cells into light sensors? What resonates with me about this remarkable study by José-Alain Sahel and colleagues in the New England Journal of Medicine, and the accompanying editorial by Nobel laureate Karl Deisseroth, is the possibility of restoring function even after the cells responsible for vision have been lost. In 10 individuals with advanced retinitis pigmentosa, an inherited disease that destroys the retina's light-sensing cells, researchers used optogenetics, a technique that introduces light-sensitive proteins into surviving nerve cells, combined w/ special goggles that translate visual information into light signals. Six of the 10 participants experienced clinically meaningful improvements in light sensitivity, and several demonstrated improvements in detecting or locating objects. This was a small, early-phase safety study, not a cure for blindness, and adverse events remind us that considerable work remains. What excites me most is the larger implication Deisseroth highlights: optogenetics is moving from a revolutionary laboratory tool toward a potential human therapy. We may not always need to replace every neuron lost to disease. Sometimes we may be able to reprogram surviving circuits to recover meaningful function. For those of us working in Parkinson's disease and deep brain stimulation, this is an especially powerful concept. The future of neurology may depend not only on protecting neurons, but also on learning how to restore the functions of circuits that survive.
https://www.nejm.org/doi/full/10.1056/NEJMoa2602215?query=featured_neurology-neurosurgery by @michaelokun

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Grocery Shopping with Parkinson's: What Should You Buy? | The Parkinson's Plate. What should you put in your grocery cart if you have Parkinson's disease? Join me and registered dietitian Emily Truscott, MS, RD, LD, as we take The Parkinson's Plate to the grocery store. Eating well with Parkinson's does not have to be complicated, and there is no single diet that works for everyone. Our goal is to help folks living with Parkinson's and their families think about everyday food choices, build healthy shopping habits, and make nutrition a practical part of their Parkinson's plan. Good nutrition starts with choices we can make every day, and sometimes the best place to begin is in the grocery aisle.
https://youtube.com/shorts/D0ZzFXByuCQ by @michaelokun

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Carbs aren’t off the table when you’re eating with Parkinson’s. 🍞
Bread, pasta, rice, potatoes, beans, legumes and fruit are all sources of carbohydrates, which the Parkinson’s Plate describes as the body’s main source of energy.
The bigger question is often which carbohydrates to choose. A Mediterranean-style approach emphasizes whole grains, including 100% whole-grain breads, pastas, cereals and rice. Whole-grain choices can also help increase fiber intake.
This grocery-store conversation takes a closer look at bread, whole grains and everyday carb choices, and how they can fit into a balanced approach to eating with Parkinson’s.
For more guidance on nutrition, recipes and making practical food choices, discover The Parkinson’s Plate. 📚
Get your copy online or from a bookstore near you!
[Parkinson’s nutrition, carbohydrates and Parkinson’s, bread and Parkinson’s, whole grains, whole grain bread, Parkinson’s diet, Mediterranean diet, Parkinson’s Plate]
#TheParkinsonsPlate #ParkinsonsNutrition #WholeGrains #ParkinsonsDiet #RobertRoseBooks by @michaelokun

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Could obesity be quietly aging our brains and increasing our risk of dementia? Obesity refers to excess body fat that can negatively affect health, including brain health. Cali McEntee, Eva Feldman and colleagues describe in a new review in Nature Reviews Neurology how obesity may affect memory, thinking and the biological pathways involved in dementia.
Key points:
- Midlife obesity is associated w/ cognitive decline and an increased risk of dementia, even when weight decreases later in life.
- Obesity may affect the hippocampus and prefrontal cortex, brain regions essential for memory, attention and decision-making, through inflammation, insulin resistance and vascular dysfunction.
- Exercise, healthier nutrition, weight-loss surgery and newer weight-management medications offer potential opportunities to improve metabolic health and possibly protect cognition, although more definitive trials are needed.
My take: What resonates w/ me is that obesity is not simply a number on a scale. It is a biological condition that can influence how our brains function and age. The brain and body are not separate universes. Inflammation, blood vessel health, insulin signaling and metabolism all matter. Perhaps most importantly, the timing of obesity matters. Carrying excess weight in midlife may have consequences that are not completely reversed by losing weight decades later.
Here are 5 points that resonated w/ me:
1- Midlife may represent an important window of opportunity for protecting long-term brain health.
2- Where fat accumulates may matter as much as how much we weigh, particularly when it collects around the abdomen.
3- Obesity can create a vicious cycle in which inflammation disrupts the brain circuits controlling appetite, potentially promoting further weight gain.
4- Exercise, nutrition and appropriate medical treatment should be viewed as investments in brain health, not simply strategies for changing appearance or body weight.
5- We still need randomized trials to establish whether treating obesity actually prevents dementia, but the opportunity to improve metabolic and vascular health is already in front of us.
https://www.nature.com/articles/s41582-026-01251 by @michaelokun

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