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Short- and long-term motor outcome of STN-DBS in Parkinson’s Disease: focus on sex differences

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Abstract

Introduction

Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for patients with Parkinson’s disease (PD) with motor complications; the contribution of sex in determining the outcome is still not understood.

Methods

We included 107 patients (71 males) with PD consecutively implanted with STN-DBS at our center. We reviewed patient charts from our database and retrospectively collected demographical and clinical data at baseline and at three follow-up visits (1, 5 and 10 years).

Results

We found a long-lasting effect of DBS on motor complications, despite a progressive worsening of motor performances in the ON medication condition. Bradykinesia and non-dopaminergic features seem to be the major determinant of this progression. Conversely to males, females showed a trend towards worsening in bradykinesia already at 1-year follow-up and poorer scores in non-dopaminergic features at 10-year follow-up. Levodopa Equivalent Daily Dose (LEDD) was significantly reduced after surgery compared to baseline values; however, while in males LEDD remained significantly lower than baseline even 10 years after surgery, in females LEDD returned at baseline values. Males showed a sustained effect on dyskinesias, but this benefit was less clear in females; the total electrical energy delivered was consistently lower in females compared to males. The profile of adverse events did not appear to be influenced by sex.

Conclusion

Our data suggest that there are no major differences on the motor effect of STN-DBS between males and females. However, there may be some slight differences that should be specifically investigated in the future and that may influence therapeutic decisions in the chronic follow-up.

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Availability of data and material

Original data are available upon reasonable request.

Code availability

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Authors and Affiliations

  1. Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy

    Nico Golfrè Andreasi, Luigi Michele Romito, Roberta Telese, Roberto Cilia, Antonio Emanuele Elia, Alessio Novelli, Grazia Devigili, Sara Rinaldo & Roberto Eleopra

  2. Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy

    Giovanni Tringali, Giuseppe Messina, Vincenzo Levi & Angelo Amato Franzini

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  1. Nico Golfrè Andreasi
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  2. Luigi Michele Romito
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Correspondence to Nico Golfrè Andreasi.

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This work is based on retrospective clinical data and does not require specific approval from our Ethical Committee.

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All the authors have read and approved the current version of the manuscript and agreed for its publication.

Conflict of interest

NGA, LR, RT, RC, AEE, AN, GT, GM, GD, SR, AAF, RE have no financial disclosures to report. VL has been medical advisor at Newronika SRL (Neuromodulation system manufacturer) from December 2018 to December 2019.

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Golfrè Andreasi, N., Romito, L.M., Telese, R. et al. Short- and long-term motor outcome of STN-DBS in Parkinson’s Disease: focus on sex differences. Neurol Sci 43, 1769–1781 (2022). https://doi.org/10.1007/s10072-021-05564-w

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