2024 presidential election

What's Going On With

What’s Going On With Putin?

                        Robert A. Levine, M.D.  March 8, 2023

I am a retired neurologist. Last week, I watched a five to ten second video of President Putin’s meeting with Lukashenko in a villa outside of Moscow online. Instead of being seated behind a table which would hide his lower body, he was in a chair with nothing blocking his legs. During the period he was visible, constant movements of both legs were noted in an asynchronous fashion. One might call these “restless legs,” but medically they looked like a syndrome called akathisia or psychomotor restlessness. Minimal movements of the hands and fingers were also noted.

Akathisia is most often caused by an adverse reaction to drugs, particularly with anti-psychotic medications. However, other drugs can also be responsible less often, including antidepressants such as tricyclic medications (nortriptyline and amitriptyline) and (SSRIs) selective serotonin uptake inhibitors (Prozac, Zoloft, Paxil, Celexa, Lexapro). In addition, calcium channel blockers (Cardizem), which are utilized for high blood pressure can rarely produce akathisia. Even if Putin is taking anti-psychotic medications, it does not indicate he is psychotic as some physicians may also prescribe these drugs for anxiety. And he may be taking anti-depressants or calcium channel blockers and having an adverse response, though akathisia is seen uncommonly with these compounds.

The National Library of Medicine of the NIH also mentions that akathisia can be seen with anti-emetic drugs (Compazine), drugs for vertigo, sedatives used for anesthesia, and abuse of cocaine.

Other considerations besides akathisia for Putin’s leg movements include the possibility of a tardive dyskinesia which can also occur with the above medications, or when they are withdrawn. However, movements of the arms and facial tics are present more often with tardive dyskinesia than mainly leg movements.

Less likely possibilities are that Putin has a neurodegenerative disorder or a movement disorder such as Parkinson’s or one of its associated syndromes. There are medications that can treat akathisia, but Putin may not even be aware of his problem or may not want any additional medications. And the treatments are not always successful. Those used include mirtazapine, beta blockers and anticholinergic compounds. The mechanism in the brain that produces akathisia is uncertain, but may have to do with dopamine or other neurotransmitters, and an imbalance between neurotransmitter systems, such as dopamine and acetylcholine. A blockage of dopamine type 2 receptors is also a consideration. There are no specific laboratory tests that can help with the diagnosis of akathisia. It is merely a diagnosis made by observation.

Patients with akathisia usually feel restless with a need to move. They may also feel subjectively uncomfortable. The akathisia may be short lasting or may persist indefinitely, even after the precipitating medications are withdrawn and treatment is initiated. We don’t know how long Putin has had these movements as there have not been videos of him with his legs exposed. Usually, he has been seen sitting at a long table, with his advisors or guests at the far end. There have been suggestions that this was a manifestation of paranoia, as Putin was afraid of catching Covid or of being assassinated. But perhaps this was related to his akathisia.

As far as we know, Putin is cognitively intact, but it would be helpful if his physicians told the world what is going on since he is the leader of a powerful nation with nuclear weapons. However, Putin wants to project an aura of strength and determination to the world and certainly does not want it known that he has an illness of any sort or is taking medications on a regular basis. In an autocratic state, the leader controls the release of all information, particularly those of a personal nature.


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Where Did Trump Go?

Where Did Trump Go?

            Robert A. Levine   12-12-2022

Since Donald Trump announced his candidacy for president in 2024 election, he has been mostly out of sight. Unlike his usual parade of public appearances and rallies, he has been keeping a low profile, with few pronouncements other than his recurrent lament of the 2020 presidential election being stolen from him. Instead of pushing his candidacy, as would be expected, he has had little to say. What had happened to the usually ebullient, narcissistic and loud mouthed Donald?

There are a number of possibilities for his public reticence. One is that he is sick or simply tired. The Donald is not a young man, is obese and has risk factors for cardio-vascular disease. However, for someone who has been almost continuously in the public spotlight for the last eight years, one would have anticipated that some word would have leaked if he were ill in any way. Political fatigue is also an unlikely factor. Trump is a man who always likes to be in the public arena and has been a very energetic figure in the political world. It would be very unusual for him to recede into the background because he is too fatigued to get out there and spout off with his normal bravado, to elicit support from his base and antagonist responses from his adversaries.

Another consideration is that The Donald and his team are reassessing their political approach, particularly after the poor showing of Trump endorsed candidates in the recent elections. The loss in Georgia by Trump supported Hershel Walker in the Senate race was also a tough blow for him. The only prominent Trump acolyte who won was J.D. Vance as Senator in the Ohio election. Not only did most Trump endorsed candidates lose, but many of them asked him to stay away from their campaigns, and many barely mentioned his endorsement as they felt it might hurt rather than help them. His constant moaning about the 2020 election being stolen from him even though it has been thoroughly disproved, is old news. Many Republicans want to project a forward looking image and are reluctant to be weighed down by Trump’s baggage.

Yet another possibility is that The Donald is aggravated by the number of Republicans who seem willing to challenge him to be the next GOP candidate for president in 2024. The front-runner of course is Governor Ron DeSantis of Florida, for whom Trump has already devised a derogatory nickname- Ron DeSanctimonious. This early attack by The Donald shows that he is taking deSantis seriously and sees him as a serious opponent. Other possible contenders who seem willing to throw their hats into the ring are Governor Glenn Youngkin of Virginia and former Governor Larry Hogan of Maryland. Former Congresswoman Liz Cheney is another possibility, but it is unclear whether she would run as a Republican or as an independent. This is not a complete list as others have also mentioned consideration of becoming candidates.

Actually, the more candidates there are in Republican primaries, the better the chances of Trump receiving the nomination. Much of Trump’s base is extremely loyal to him and would vote for him in a primary, while the other candidates would split the remaining vote. In this way, Trump might win even with a small percentage of the total Republican primary vote.

But aside from the next election which is two years off, The Donald may be upset by being blamed by many conservative pundits for the poor showing of his handpicked Republican candidates in the 2022 elections. In addition, some recent polls have showed Ron DeSanctimonious ahead of Trump as the desired Republican candidate for president. Trump may also be bothered by all the legal actions to which he is being subjected, his New York company already having been found guilty of fraud. And he has barely started running through his legal gauntlet.

The 2024 is still two years off and many things may change. But the question now remains- where did the usual Donald Trump go?


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