The brains of men and women do not present significant differences in childhood, but the impact of sexual hormones throughout the lives of both of them imprints their own characteristics. Together with social influence and greater longevity, they contribute to the fact that female and male neurological diseases have different impact, severity and prevalence. For various reasons, they bear the brunt: they suffer more serious strokes with a worse prognosis; 80% of cases suffer from migraine and two thirds from Alzheimer’s (although less from Parkinson’s); Multiple sclerosis is three times more common in women and there are 50% more insomniacs among them.
The Spanish Society of Neurology (SEN) published this Tuesday the book Neurology and Women, the first guide of this specialty focused on female diseases. It aims to help in the clinical practice of doctors, with updated information and tools to differentially treat ailments according to sex.
Susana Arias, one of the publication’s coordinators, explains that the greater life expectancy of women is one of the keys. In Spain, they live an average of five years longer than men, which means that most of their deaths are due to cerebrovascular diseases. “They have more strokes, more serious ones, with a greater risk of institutionalization and dependency,” she points out.
But it’s not just longevity that explains the difference. Arias gives the example of migraine: “Until puberty it has a similar incidence in boys and girls. But with hormonal cycles it becomes much more prevalent in women.” And she uses this same disease to illustrate how the social context influences it: “A woman who suffers from it at a stage of professional development knows that it is disabling, but many times she endures it in a stoic way because she does not want to allow herself to ask for the tranquility and darkness that she needs.” “so as not to miss opportunities, something that is not so common in men.”
The problems in treating diseases in women begin in basic research. Animal models have often ruled out female mice to avoid hormonal cycles because they could supposedly skew the results. “But we know that we must precisely take these cycles into account,” claims Arias. In clinical trials with humans, history repeats itself: “The risk of pregnancy means that fewer women are recruited, and they themselves are less likely to enter trials at fertile age due to uncertainties about the interactions of the treatments.”
The guide is intended to help doctors understand how hormones and certain neurological diseases interact and to take social factors into account. “We cannot leave a woman without treatment orphaned because she takes a contraceptive, she is breastfeeding, she is pregnant or she wants to be. It is important to be up to date with the databases of women who became pregnant with one or another drug to know if it is more or less safe to use them,” adds Arias. The publication reviews groups of diseases, these are (very roughly) some of the notes that its more than 300 pages delve into:
Cerebrovascular diseases
The incidence of cerebrovascular diseases is similar between men and women in the 20 to 59 age range, while it is higher in men between 60 and 79 years of age and higher in women from 80 years of age. The longevity of women makes it more likely that they will suffer from it after the 50s, so the risk of having a stroke throughout life is greater than in men. The guide points out that, in addition, there are studies that show that the global incidence of cerebral infarctions is decreasing, but at the cost of a decrease in men, while it remains stable in women. One of the most described factors that could contribute to the differences between the two sexes is the hormonal situation: estrogen values decrease significantly during menopause, and it is known that one of them, estradiol, has a positive effect on the regulation of Blood flow.
Demyelinating diseases
Multiple sclerosis is diagnosed in three women for every man and, for the most part, it occurs during childbearing age. The publication assures that “a significant percentage” of women with this disease express their desire to have children, so the challenge for neurologists is to help plan the best moment of pregnancy, “taking into account the balance between benefit and risk for both mother and child.”
Cognitive impairment
The underlying mechanisms in cognitive deterioration are related to hormonal changes, affective disorders or diseases that are more prevalent in the female sex. “In some women, several causes come together at the same time, such as the perimenopausal period, in which hormonal changes, sleep and mood disorders occur, or the frequent association of fibromyalgia, depression and functional cognitive disorder. The greater incidence and severity of deterioration in women has also been related to sociocultural environments that condition them to have less cognitive reserve, such as showing lower levels of education than those of men,” the guide points out.
Regarding Alzheimer’s, two out of every three diagnosed patients are women who, in addition to suffering from the disease, are the main caregivers of patients with dementia, which also influences their health.
Functional neurological disorders
Functional neurological disorders are syndromes that include tremor, gait disorders, weakness, dizziness, dissociative crises, sensory and cognitive alterations. “They are very common, often disabling, and significantly alter the quality of life of patients.” Most studies indicate a ratio of two or three women for every affected man. “The fact that these disorders are predominantly female has played a relevant role in how they have been understood throughout history: from the hysteria defined by Hippocrates in the 5th century BC, through the exorcisms of possessed from the Middle Ages, to Freud’s theory of conversion,” the book states.
The publication explains that after centuries of simplistic and purely psychological explanations (with diagnoses such as psychosomatic, psychogenic, conversion or non-organic), in the last two decades there has been a “true neuroscientific explosion” that has “radically” changed the vision of these disorders. “Today we know that they are produced by alterations in multiple circuits that involve the processing of attention, the sensation of agency (the ability of the individual to feel master of his movements), emotions, motor control and speech.” There are brain changes that demonstrate that continuing to call these disorders “non-organic” goes against scientific knowledge, which is why the SEN proposes addressing them in a radically different way than has been done, or even how it continues to be done in some cases.
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