Gender gap in deep brain stimulation for Parkinson's disease

Stefanie T Jost; Lena Strobel; Alexandra Rizos; Philipp A Loehrer; Keyoumars Ashkan; Julian Evans; Franz Rosenkranz; Michael T Barbe; Gereon R Fink; Jeremy Franklin; Anna Sauerbier; Christopher Nimsky; Afsar Sattari; K Ray Chaudhuri; Angelo Antonini; Lars Timmermann; Pablo Martinez-Martin; Monty Silverdale; Elke Kalbe; Veerle Visser-Vandewalle; Haidar S Dafsari; EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group

doi:10.1038/s41531-022-00305-y

Gender gap in deep brain stimulation for Parkinson's disease

NPJ Parkinsons Dis. 2022 Apr 20;8(1):47. doi: 10.1038/s41531-022-00305-y.

Authors

Stefanie T Jost^#¹, Lena Strobel^#², Alexandra Rizos³, Philipp A Loehrer⁴, Keyoumars Ashkan³, Julian Evans⁵, Franz Rosenkranz², Michael T Barbe², Gereon R Fink^{2

6}, Jeremy Franklin⁷, Anna Sauerbier², Christopher Nimsky⁸, Afsar Sattari^{9

10}, K Ray Chaudhuri^{3

11

12}, Angelo Antonini¹³, Lars Timmermann⁴, Pablo Martinez-Martin¹⁴, Monty Silverdale⁵, Elke Kalbe¹⁵, Veerle Visser-Vandewalle¹⁶, Haidar S Dafsari¹⁷; EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group

Affiliations

¹ Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany. stefanie.jost@uk-koeln.de.
² Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
³ Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.
⁴ Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.
⁵ Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, UK.
⁶ Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.
⁷ Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany.
⁸ Department of Neurosurgery, University Marburg, Marburg, Germany.
⁹ University of Cologne, Faculty of Humanities, Cologne, Germany.
¹⁰ German Association of Women Engineers, Cologne, Germany.
¹¹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹² NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
¹³ Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy.
¹⁴ Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain.
¹⁵ University of Cologne, Faculty of Medicine, Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Interventions (CeNDI), Cologne, Germany.
¹⁶ Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁷ Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany. haidar.dafsari@uk-koeln.de.

^# Contributed equally.

Abstract

Previous studies have shown less access to deep brain stimulation (DBS) for Parkinson's disease (PD) in women compared to men raising concerns about a potential gender gap resulting from nonclinical factors or gender differences in clinical efficacy for postoperative quality of life (QoL), motor, and nonmotor symptoms (NMS) outcomes. This was a cross-sectional and a longitudinal, prospective, observational, controlled, quasi-experimental, international multicenter study. A total sample size of 505 consisted of 316 consecutively referred patients for DBS indication evaluation at the University Hospital Cologne (01/2015-09/2020) and 189 consecutively treated patients at DBS centers in the University Hospitals Cologne and Marburg, Salford's Royal Hospital Manchester, and King's College Hospital London. In the cross-sectional cohort, we examined gender proportions at referral, indication evaluations, and DBS surgery. In the longitudinal cohort, clinical assessments at preoperative baseline and 6-month follow-up after surgery included the PD Questionnaire-8, NMSScale, Scales for Outcomes in PD-motor scale, and levodopa-equivalent daily dose. Propensity score matching resulted in a pseudo-randomized sub-cohort balancing baseline demographic and clinical characteristics between women with PD and male controls. 316 patients were referred for DBS. 219 indication evaluations were positive (women n = 102, respectively n = 82). Women with PD were disproportionally underrepresented in referrals compared to the general PD population (relative risk [RR], 0.72; 95%CI, 0.56-0.91; P = 0.002), but more likely to be approved for DBS than men (RR, 1.17; 95%CI, 1.03-1.34; P = 0.029). Nonetheless, their total relative risk of undergoing DBS treatment was 0.74 (95%CI, 0.48-1.12) compared to men with PD. At baseline, women had longer disease duration and worse dyskinesia. Exploring QoL domains, women reported worse mobility and bodily discomfort. At follow-up, all main outcomes improved equally in both genders. Our study provides evidence of a gender gap in DBS for PD. Women and men with PD have distinct preoperative nonmotor and motor profiles. We advocate that more focus should be directed toward the implementation of gender equity as both genders benefit from DBS with equal clinical efficacy. This study provides Class II evidence of beneficial effects of DBS in women with PD compared to male controls.