User:Doug Weller/Okun

Okun designed and carried out one of the first large prospective randomized Parkinson’s disease trials comparing the two most common DBS brain targets. The study, known as the NIH COMPARE trial, revealed unilateral STN or GPi DBS resulted in similar motor benefits, however there were important advantages and disadvantages for using each brain target. An editorial in Archives of Neurology, The Rematch,48 raised the question that would later shift the future of DBS care to symptom specific profiles49. Okun, Vitek, DeLong and Foote were widely criticized in the field for their early use of the GPi DBS target, however following multiple international studies, the use of the target has become mainstream and the field has shifted toward more about symptom specific deep brain stimulation profiles, as opposed to being disease specific50,51. Okun and colleagues determined the most common cognitive side effect of Parkinson’s DBS surgery was verbal fluency and that the issue was mainly related to passing the probes, and not as related to the application of electricity47,52. Later, the large VA prospective multicenter DBS study was published53,54 using bilateral STN or GPi DBS and the results revealed a similar outcome to NIH COMPARE; with the main difference that this cohort was larger and the brain implants were bilateral. Okun and Foote developed screening systems and a commonly used fast-track evaluation for multidisciplinary screening of deep brain stimulator implants. 1,2,4,11,40,55-61. They also developed a commonly utilized DBS imaging protocol and the Fast Gray Matter Acquisition T1 Inversion Recovery (FGATIR) sequence with Frank Bova PhD who also developed a home grown DBS targeting system.62,63 The imaging protocol was named after the University of Florida “gator” mascot. Okun, Foote and Bova all hold multiple patents for DBS and brain surgery related interventions.

Okun and Foote embraced the idea of the operating theater being used to conduct human experiments. Together, they were among the first to describe several human intraoperative stimulation induced effects, including smile25, panic26, pseudobulbar affect30 and most recently memory flashbacks.64 The two doctors had an early awareness that the misuse of the technology could lead to future ethical issues. Okun and Foote introduced the neuroethical guiding principle for the appropriate use of deep brain stimulation; “it should only be applied to alleviate human suffering,” which was laid out in a 2015 TEDx talk https://www.youtube.com/watch?v=7udZ5ux0dYE. Their work on the ethics of DBS and psychosurgery has been covered in the Smithsonian magazine https://www.smithsonianmag.com/innovation/inside-science-amazing-new-surgery-called-deep-brain-stimulation-180951170/ by David Noonan and also featured in the movie Hunting for Hedonia https://www.dfi.dk/en/viden-om-film/filmdatabasen/film/hunting-hedonia by Danish filmmaker Pernille Rose Grønkjær.

Okun and Foote co-founded the Deep Brain Stimulation Think Tank in 2012. https://fixel.ufhealth.org/research/deep-brain-stimulation-think-tank/think-tank-published-proceedings/ The original idea for the DBS Think Tank was to gather approximately 50-100 of the top experts in the field and to lock them in a room, drive collaboration, share information, catalyze cutting edge innovation and to proactively address the ethical issues involved in current and future neuromodulation. The DBS Think Tank has grown into an important coalition of experts advocating for device access and reimbursement. The group has been active with the NIH, the FDA and payor systems. The members of the tank, which include doctors, scientists, engineers, patients and other stakeholders work together to drive dialogue on cutting edge technologies and also to address the neuroethics of brain implants. There is an annual DBS think tank proceedings paper released each year following the meeting.1,2,4,11,40,55-57

Okun is credited with coining the phrase, “the patient is the sun and we should orbit around the patient,” In 2002 he and Foote founded the Program in Movement Disorders at the University of Florida. Since that time the program has transformed into a “model for care and research,” with many international visitors. It has grown from program to center to institute and finally to the Norman Fixel Institute for Neurological Diseases (2019). Their original vision was a one-stop patient-centered clinical-research experience for both national and international patients. This model for care and research delivery was published in JAMA Neurology and has been referred to as the service and science hub model of care.65 The model includes the ideas that care should be conducted all under one roof, every patient should be a clinical patient and a research patient (enrolled in a database) and there should be access to clinical trials. Okun, along with Professor Bastiaan Bloem (Nimegen, Netherlands) and Ray Dorsey (University of Rochestor, NY) have been vocal advocates for building better models for interdisciplinary care for Parkinson’s disease inclusive of virtual telemedicine visits.66-72 Okun is known as a strong patient advocate for Parkinson’s disease and has promoted multidisciplinary care worldwide through his role Medical Director/Advisor role with the Parkinson’s Foundation and through his patient facing blog http://parkinsonsecrets.com which offers tips for those with the disease. The University of Florida INFORM database, which spawned from the service and science hub effort,65 has become one of the largest real-world Parkinson’s and movement disorders databases in the world, and is managed by Charles Jacobson. The database was used as one of the models for the Parkinson’s Foundation QII Parkinson’s Outcome Project73 for which Okun served as a founding steering committee member during its creation. In his role as the Medical Director for the Parkinson’s Foundation, Okun was instrumental in leading interdisciplinary research across Parkinson’s Foundation Centers of Excellence, particularly in the area of hospitalization74-77 and he was part of the group to devise and to distribute over 100,000 Aware in Care Hospitalization bags. The contents of the Aware in Care kits can now be freely downloaded and have been used by thousands of people to prevent medical errors and to protect Parkinson’s patients during hospitalizations. https://www.parkinson.org/Living-with-Parkinsons/Resources-and-Support/Hospital-Kit