Objective: To investigate gender differences in quality of life, motor, and nonmotor symptoms (NMS) in patients with Parkinson’s disease (PD) undergoing subthalamic nucleus deep brain stimulation (STN-DBS).

Background: Recent research has shown that women are less likely to undergo DBS.¹ However, little is known about gender-related differences in postsurgical outcomes or distinct preoperative motor and nonmotor profiles that could explain this ‘gender gap’.

Method: In this ongoing, prospective, observational, multicenter international study, we analyzed gender differences in patients undergoing STN-DBS using the NMSScale (NMSS), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD (SCOPA), Hospital Anxiety and Depression Scale (HADS), and levodopa equivalent daily dose (LEDD). We used Mann-Whitney U tests to compare preoperative gender differences and differences in outcome changes at 12-month follow-up.

Results: Based on our cohort including 128 patients (men n=77), women had longer disease duration (p=.007) and higher scores in SCOPA-items for dyskinesia (p=.005) and axial symptoms (p=.021), while men had higher tremor scores (p=.041). LEDD, NMSS total score and PDQ-8 Summary Index did not differ significantly between men and women. In explorative analyses of NMSS and PDQ-8 items at baseline, we found significant gender differences in ‘depression’ (p=.010), ‘excessive sweating’ (p=.002), ‘difficulty getting around in public’ (p=.035) and ‘painful muscle cramps’ (p=.005), with women reporting more severe impairment. On the contrary, men stated more ‘problems having sex’ (p=.012). Postoperatively, we observed no significant gender differences in mean changes at 12-month follow-up for all outcome parameters except for the HADS-depression score with men having more beneficial treatment effects compared to women (p=.032).

Conclusion: Women and men appear to have distinct motor and nonmotor profiles at preoperative baseline. However, STN-DBS induced similar benefits in both genders, although depressive symptoms improved only in men. This study highlights the importance of equal access to advanced treatment options like STN-DBS. Further studies are needed investigating the reasons for the disadvantages faced by women relating to treatment with DBS.

References: 1. Shpiner DS, Di Luca DG, Cajigas I, et al. Gender Disparities in Deep Brain Stimulation for Parkinson’s Disease. Neuromodulation : journal of the International Neuromodulation Society 2019;22(4):484-488.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gender-related-differences-in-nonmotor-symptoms-in-the-context-of-subthalamic-stimulation-in-parkinsons-disease/