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” I keep trying to lose weight but it keeps finding me!…”

As I have mentioned several times in the past, I am particularly interested in women’s issues as they relate to Parkinson’s disease because I believe (and fortunately others are beginning to agree with me) that gender does matter in the presentation, disease progression, response to treatment, and most importantly outcome. Over the last month I have been particularly interested in weight changes with PD in light of the fact that I have put on several extra pounds with the medication changes. Many of us know first -hand, that weight issues are yet another aspect of living with PD; yet it seems to me that us women appear to have the short end of the stick in this regard particularly when it comes to weight increase after DBS.

In my practice it seemed to me that men rarely complained about weight issues unless the spouse4s or care takers were concerned about their persistent weight loss. On the other hand, the women always seemed to complain of increased girth, which I am sure many of you can relate especially after menopause there is already a tendency for weight gain. At the time, I attributed some of this behavior to inactivity as well as depression which usually causes an increase in sedentary life thus decreasing caloric consumption. (This was the accepted concept within my profession). But, after living with this illness for lo this many years and being around a greater number of patients of all ages, I am not entirely sure this is the correct assumption.

I firmly believe the differences are rooted in gender particularly as it relates to estrogen. Why else would there seem to be an increase in weight in women after DBS particularly the STN (sub thalamic nucleus which is most common site for dyskinesia treatment) transplant not typically seen in men of same age, ethnicity and disease stage? Weight gain post dbs occurs in about 30% of those implanted and appears to be gender specific. Several of my close female friends who have undergone this procedure although has worked very well in controlling symptoms of PD has caused an increase in weight and not necessarily because of decrease in energy expenditure from dyskinesia’s. This can be further substantiated by a study looking at the weight changes with DBS in both men and women. Patients post DBS had on average of 6.6 lbs. by 3 months up to 44 lbs. in a year. Interestingly, women gained mostly fat while men increased fat free mass. This is huge in my mind and suggests to me that we should start treating women and men differently after surgery and even before to decrease risk of weight gain which also increases the potential for cardiac and cerebrovascular events for which women with PD are already at higher risk, as well as metabolic disorders like diabetes. Both diabetes and insulin resistance risk increases with dopamine replacement. We still don’t know for certain what causes this metabolic changes. Some speculate that is the sudden loss of energy expenditure from muscle rigidity, dystonia, and dyskenesias. Others think it could be affecting the sympathetic nervous system controlling organs. In men there was no change in testosterone but no mention of estrogen levels recorded. Best outcomes with the lowest weight gain occurred in patients who had the worst UPDRS 111 scores before surgery (i.e. had significant improvement with dopamine and severe “off”).

Advice based on this findings before doing dbs: talk to your physician and be informed.

  1. Because it occurs with b/l stn surgery (no other data available) consider unilateral or different site?
  2. There is a case for doing procedure on the RIGHT patient and in the right window.
  3. Submitting yourself to a strict program before and after to control weight which includes decreased lipid intake and increased exercise, progressive physical training early post-surgery.
  4. Check for metabolic abnormalities such as thyroid and insulin resistance which can increase weight.