Objective: To examine DBS surgery outcomes within the Deep Brain Stimulation (DBS) PD cohort at the NIH among males and females and improve our understanding of the known gender disparities in DBS.

Background: DBS is an effective treatment for the motor symptoms of Parkinson’s Disease (PD), with the subthalamic nucleus (STN) being the preferred target. Females undergo DBS surgery at a lower rate compared to males, disproportionate to the gender discrepancy in PD. Previous studies examining gender differences in outcomes of STN DBS have found conflicting results.

Method: A retrospective study was performed on data from subjects who underwent STN DBS for PD at the NIH and completed their 24-month visit. Subjects had a diagnosis of PD from a Movement Disorders Neurologist at the NIH, a 30% improvement in motor Unified Parkinson’s Disease Rating Scale (UPDRS) with dopaminergic medication or dopaminergic resistant tremor, and unsatisfactory clinical response to maximal medical management. Patients with severe medical conditions, dementia, cognitive impairments and unstable psychiatric disorders were excluded from DBS. Data analyzed from the baseline, 3-month and 24-month follow-up visits included the UPDRS, neuropsychological testing and Levodopa Equivalent Drug Dosing (LEDD).

Results: Seventy-two patients (50 male, 22 female) were included. No significant difference in age of onset, disease duration at time of surgery and age at time of surgery between males and females was found. Males had a significant reduction in the Dementia Rating Scale (DRS) compared to females at 3-months.  At baseline females had higher UPDRS dyskinesia subscores and at 24 months females had greater improvement in UPDRS IV total scores. There were no significant differences in other measured variables at baseline, 3 months and 24 months.

Conclusion: Within our cohort there are distinct differences between UPDRS IV and dyskinesia sub-scores at baseline and UPDRS IV improvement at 24 months, between males and females. Due to the conflicting results in previously published literature, it is difficult to conclude whether significant gender differences exist in outcomes following DBS surgery. A meta-analysis of previous work on this subject, or a larger sample would be required to definitively determine the impact that gender has on DBS outcomes in PD.

Table 1: DBS outcomes at baseline, 3 and 24 months

References: 1. Volkmann J. Deep brain stimulation for the treatment of Parkinson’s disease. J Clin Neurophysiol. 2004;21(1):6-17. doi:10.1097/00004691-200401000-00003
2. Hariz M, Blomstedt P. Deep brain stimulation for Parkinson’s disease. J Intern Med. 2022;292(5):764-778. doi:10.1111/joim.13541
3. Shpiner DS, Di Luca DG, Cajigas I, et al. Gender Disparities in Deep Brain Stimulation for Parkinson’s Disease. Neuromodulation: Technology at the Neural Interface. 2019;22(4):484-488. doi:https://doi.org/10.1111/ner.12973
4. Hendriks M, Ruben Saman Vinke, Georgiev D. Gender discrepancies and differences in motor and non-motor symptoms, cognition, and psychological outcomes in the treatment of Parkinson’s disease with subthalamic deep brain stimulation. Frontiers in Neurology. 2024;14. doi:https://doi.org/10.3389/fneur.2023.1257781

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gender-differences-following-bilateral-stn-dbs-surgery-in-parkinsons-disease/