STN-DBS Leads to Similar Benefits in Men and Women with Parkinson’s, Study Finds

STN-DBS men women

Apart from physical health-related quality of life — which seemed to improve to a greater extent in males — the benefits of subthalamic nucleus deep brain stimulation (STN-DBS) on motor, cognitive, and mental function are similar in men and women with Parkinson’s disease, a study has found.

The study, “Sex differences in the short-term and long-term effects of subthalamic nucleus stimulation in Parkinson’s disease,” was published in Parkinsonism and Related Disorders.

STN-DBS is a non-destructive surgical treatment for Parkinson’s disease that involves implanting a device to stimulate targeted regions of the brain with electrical impulses generated by a battery-operated neurostimulator.

Since its implementation, STN-DBS has become an accepted and effective therapeutic option to treat motor symptoms associated with Parkinson’s. It also is used to treat other complications caused by prolonged dopaminergic treatment in advanced forms of the disease.

“There have been discussions on the influence of sex on the effect of STN-DBS in PD. Several short-term studies have suggested that overall improvements in motor and non-motor symptoms following STN-DBS are similar between male and female PD patients, whereas the short-term results on sex differences in postoperative health-related quality of life (HRQoL) are inconsistent,” the researchers said.

In this study, a team of Korean scientists set out to investigate the influence of sex on short- and long-term effects of STN-DBS in Parkinson’s.

The prospective study analyzed the medical records of 48 men and 52 women with the disease who received STN-DBS between 2005 and 2013 at the Movement Disorder Center of Seoul National University Hospital (SNUH) and were followed for at least five years.

The patients’ motor, cognitive and mental function, as well as health-related quality of life, or HRQoL, were assessed in all participants at the start of the treatment (baseline), and at one and five years of follow-up. HRQoL was assessed using the 36-Item Short Form Health Survey (SF-36), which contains physical and mental component subscores.

With the exception of the physical component of the SF-36, no differences were found between men and women in the effects of STN-DBS on any of the clinical parameters from baseline to follow-up.

STN-DBS led to significant improvements in the physical component of the SF-36 in individuals from both sexes from baseline to one year of follow-up. However, this positive effect was more pronounced among men than among women.

In addition, the researchers found that improvements in the physical component of the SF-36 from baseline to five years of follow-up were only statistically significant in men.

“In conclusion, we found that STN-DBS led to a similar degree of short-term and long-term effects on motor function, depressive and cognitive symptoms, and functional status between male and female PD patients,” the researchers said.

“Nevertheless, the physical HRQoL appears to improve to a greater extent in men over a long-term observation,” they concluded.

The researchers said further studies are warranted “to reveal the precise mechanism underlying the sex-associated differences in postoperative HRQoL, and to design an effective strategy to improve HRQoL in women undergoing STN-DBS.”

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Review Highlights Sex-related Differences In Parkinson’s

sex-related differences

Parkinson’s disease (PD) is more common among males, but it tends to progress faster in females. This and other sex-based differences in the neurodegenerative disease were highlighted in a recent review, titled “Parkinson’s Disease in Women and Men: What’s the Difference?” and published in the Journal of Parkinson’s Disease.

The review explains the current state of scientific understanding of how Parkinson’s differs among the biological sexes in a number of regards.

The first of these is motor symptoms, which emerge later in females.

Females are more likely to have tremors as their first presenting symptom, to develop unstable postures, to have reduced rigidity, and to progress to falling. Males, on the other hand, are more likely to develop later gait freezing, and have a higher risk of developing camptocormia — an abnormal flexing of the trunk. An ongoing clinical trial (NCT03573232), sponsored by the Università di Verona in Italy, is evaluating the impact of biological sex on other postural abnormalities.

Non-motor symptoms differ between the sexes as well. Symptoms including fatigue, depression, constipation, pain, excessive sweating, fluctuations in weight, difficulty swallowing, and loss of taste or smell are more common in females, whereas males are more likely to experience cognitive impairment and impulse control disorders, for example, pathological gambling.

Beyond the manifestation of symptoms, the review notes that the mechanisms that cause PD likely differ based on sex. This includes factors ranging from different genes that may be more or less impactful in different sexes, to distinctions in the role of inflammation, to differences in brain cells themselves.

In particular, the review authors highlight the role of sex-related hormones — most notably estrogens — in the development of Parkinson’s.

“Sex hormones act throughout the entire brain of both males and females and sex differences are now highlighted in brain regions and functions not previously considered as subjected to such differences, opening the way to a better understanding of sex-related behavior and functions,” Silvia Cerri, PhD, the head of the laboratory of cellular and molecular neurobiology of the IRCCS Mondino Foundation and co-author of the review, said in a press release.

“Neuroinflammation is an important piece of the pathogenic puzzle of PD,” Cerri added. “Since estrogens have anti-inflammatory properties, their actions throughout the lifespan could partially account for sex-related risk and manifestation of PD.”

Despite these many findings, research into sex-based differences in Parkinson’s is only just beginning to yield clear answers.

“We are still far away from the actual understanding of what underlies such [sex-based] differences,” the researchers said. “Studies in this area are under-represented, both from the clinical and research perspective, especially for females.”

The review’s investigators hope that, by drawing attention to these differences, they can encourage further research in the field. This could have utility not just in understanding how the disease manifests in distinct ways in different people, but also in providing the best possible individualized treatment.

“It is a line that is worth pursuing and will deserve further attention by the scientific community and policy makers,” the authors concluded.

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