Gender gap in deep brain stimulation for Parkinson's disease

Area of Science:

• Neurology
• Neurosurgery
• Movement Disorders

Background:

• Deep brain stimulation (DBS) is a key treatment for Parkinson's disease (PD), but concerns exist regarding gender disparities in access and outcomes.
• Previous studies suggest women with PD may have less access to DBS compared to men, raising questions about clinical efficacy and quality of life (QoL).

Purpose of the Study:

• To investigate gender differences in access to DBS for Parkinson's disease.
• To compare preoperative and postoperative motor, nonmotor, and QoL outcomes between women and men with PD undergoing DBS.
• To identify potential gender-based disparities in the DBS treatment pathway for PD.

Main Methods:

• A multicenter, international study combining cross-sectional and longitudinal observational designs with 505 participants (316 referred, 189 treated).
• Propensity score matching was used to create a balanced cohort for comparing women and men with PD.
• Clinical assessments included the PD Questionnaire-8, NMSScale, Scales for Outcomes in PD-motor scale, and levodopa-equivalent daily dose at baseline and 6-month follow-up.

Main Results:

• Women with PD were underrepresented in DBS referrals (RR, 0.72) but more likely to be approved for DBS (RR, 1.17).
• Despite equal approval likelihood, women's overall relative risk of undergoing DBS was lower (RR, 0.74).
• Women presented with longer disease duration and worse baseline motor symptoms (dyskinesia) and QoL (mobility, discomfort); however, all outcomes improved equally in both genders post-surgery.

Conclusions:

• A significant gender gap exists in DBS for Parkinson's disease, affecting referral rates.
• Women and men with PD exhibit distinct preoperative motor and nonmotor profiles.
• Both genders benefit equally from DBS, underscoring the importance of implementing gender equity in PD management to ensure equal access and outcomes.