Gender Differences in Patients with Parkinson’s Disease Treated with Subthalamic Deep Brain Stimulation Ettore Accolla, MD, 1 Elena Caputo, MD, 2 Filippo Cogiamanian, MD, 1 Filippo Tamma, MD, 2 Simona Mrakic-Sposta, MS, 1 Sara Marceglia, MS, 1 Marcello Egidi, MD, 1 Paolo Rampini, MD, 1 Marco Locatelli, MD, 1 and Alberto Priori, PhD 1 * 1 Dipartimento di Scienze Neurologiche, Universita ` di Milano, Fondazione IRCCS Ospedale, Policlinico, Milano, Italy 2 Dipartimento di Neurologia Clinica, Ospedale San Paolo, Milano, Italy Abstract: We investigated gender-differences in clinical phe- nomenology and response to deep brain stimulation (DBS) of the subthalamic nucleus (STN) in a group of patients with advanced Parkinson’s disease (PD). Thirty-eight consecutive patients with PD (22 men and 16 women), bilaterally implanted for DBS of the STN, were evaluated 1 month before and 11 to 14 months after surgery. Gender differences in severity of the disease (HY and UPDRS), ability in the activities of daily living (ADL, UPDRS II), tremor and rigidity (UPDRS III), bradykinesia (UPDRS III and hand tapping test), levodopa- induced dyskinesias (LIDs, UPDRS IV), and levodopa equiv- alent daily dosage (LEDD) were analyzed before and after intervention. We found a predominantly male population, with no gender-related differences in age at onset, disease progres- sion rate, or severity of disease. Nevertheless, women had more severe LIDs than men, only before the intervention. Bradyki- nesia was significantly less responsive to any kind of treatment (pharmacologic and neurosurgical) in women than in men. Finally, although STN-DBS induced similar total benefits in both genders, postoperative assessment suggested that the ADL improved more in women than in men. Women and men with advanced PD appear to differ in some clinical features and in response to dopaminergic and STN-DBS treatment. © 2007 Movement Disorder Society Key words: Parkinson’s disease; gender; deep brain stimu- lation; subthalamic nucleus Over the past 20 years, accumulating evidence delin- eates numerous differences between female and male human brains. 1 These differences are reflected in the epidemiology, neuropathology, and clinical manifesta- tions of many neurological diseases. They are thought to arise mainly from sexual hormones that influence the development of the brain and its function in adult age. 2 Hormones are probably not the only factors responsible for gender differences in the clinical presentation of Parkinson’s Disease (PD): exposure to different profes- sional and life-style related risk factors could also play a role. Moreover, the self-assessment scales used in many studies, notably for evaluating the activities of daily living (ADL), could reflect a cultural and social differ- ence, across genders. 3 Ample evidence documents the existence of gender- related differences, notably in the epidemiology of PD, presenting symptoms, and response to dopaminergic therapy. In Western countries, the incidence of PD is reported to be higher in men than in women, with a reported male/female ratio of 1:49. 4 Symptoms and signs also seem to slightly differ between genders. In the general PD population, no differences have been found in age at onset, disease duration, or disease progression rate. 5-8 Nevertheless, women have greater difficulty than men in attending to the ADL. 6 Men seem to have more varied symptoms than women, suffering more frequently from hypophonia, lack of initiative, postural distur- bances, and hypersalivation. In contrast, women are more disturbed in their daily life by neck pain, difficul- ties in turning over in bed, gait disturbances, dry mouth, depression, and anxiety. 8 Men and women also differ in the response to oral dopaminergic therapy. In particular, *Correspondence to: Prof. Alberto Priori, Dipartimento di Scienze Neurologiche, Clinica Neurologica, Padiglione, Ponti, Ospedale Mag- giore Policlinico, Via F. Sforza 35, Milano 20122, Italy. E-mail: alberto.priori@unimi.it Received 10 November 2006; Revised 6 March 2007; Accepted 14 March 2007 Published online 27 April 2007 in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/mds.21520 Movement Disorders Vol. 22, No. 8, 2007, pp. 1150 –1156 © 2007 Movement Disorder Society 1150