Movement disorders in women: A review

Abstract

The field of women's health developed based on the recognition that there are important sex-based differences regarding several aspects of medical illnesses. We performed a literature review to obtain information about differences between women and men for neurological movement disorders. We identified important differences in prevalence, genetics, clinical expression, course, and treatment responses. In addition, we found that female life events, including menstruation, pregnancy, breast feeding, menopause, and medications prescribed to women (such as oral contraceptives and hormone-replacement therapy), have significant implications for women with movement disorders. Understanding this biological sex-specific information can help improve the quality and individualization of care for women with movement disorders and may provide insights into neurobiological mechanisms.

Comment on Szewczyk-Krolikowski et al.: The influence of age and gender on motor and non-motor features of early Parkinson's disease: Initial findings from the Oxford Parkinson Disease Center (OPDC) discovery cohort

“…Gender differences in brain structure and function as the sexrelated disparities in role expectations and social attitude may affect the presentation, course and response to treatment in a number of neurological conditions [2].…”

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SirWe read with great interest the paper "The influence of age and gender on motor and non-motor features of early Parkinson's disease: Initial findings from the Oxford Parkinson Disease Center (OPDC) discovery cohort" recently published by SzewczykKrolikowski and colleagues [1].Gender differences in brain structure and function as the sexrelated disparities in role expectations and social attitude may affect the presentation, course and response to treatment in a number of neurological conditions [2].Gender differences in relation to motor symptoms in Parkinson's disease (PD) have been extensively analyzed [3,4]. In contrast, the influence of gender on the prevalence of non-motor symptoms (NMS) has been inadequately investigated [5,6].

Through the administration of several questionnaires assessing different NMS to a large cohort of both treated PD patients and healthy controls, Szewczyk-Krolikowski et al showed that women presented with milder cognitive and sleep problems, orthostatic hypotension and sexual dysfunction, but with worse pain as compared to men.

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Sex-Related Prognostic Predictors for Parkinson Disease Undergoing Subthalamic Stimulation

“…Various animal data and clinical studies have suggested that gender plays an important role in the clinical course and therapeutic outcomes of PD [13,15,16]. For example, sex hormones (such as estrogen) modulate the activity of nigrostriatal dopaminergic neurons [15,20].…”

“…For example, sex hormones (such as estrogen) modulate the activity of nigrostriatal dopaminergic neurons [15,20]. Female PD patients develop motor symptoms at a later age than male PD patients do, and exhibit a tremor-dominant phenotype [15,16]. However, the disease progression was slightly but significantly faster in women when surveyed [18].…”

Levodopa–carbidopa intestinal gel (LCIG) infusion during pregnancy and delivery: First documented case

“…The few studies on the effect of pregnancy on PD described either no change or worsening of the symptoms [3,4], and no or minimal effect of PD on the course of pregnancy and the fetus [2]. Dopaminergic drugs are considered as pregnancy category C, but most published reports showed that the use of levodopa generally appears to be safe [4].…”