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Published on: May 17, 2014
by Olga Rukovets for Neurology Today:
Whether or not men and women really hail from two different planets, gender-based differences do affect manifestations and risk profiles for certain neurologic conditions. Research in this field, however, is severely limited and studies are often not powered to adequately address these discrepancies.
The AAN’s Section on Women’s Issues in Neurology has hopes of changing that, and incorporating these differences into study design from the outset. Section Chair Barbara Swartz, MD, PhD, FAAN, spoke with Neurology Today about the recently published American Heart Association/American Stroke Association guidelines for preventing stroke in women as an example of why gender differences should be part of a constant and ongoing discussion among researchers.
The guidelines, which were published in the February edition of the journal Stroke, pointed out risk factors that were unique or more common to women — such as pregnancy, preeclampsia, migraines, atrial fibrillation, diabetes, and hypertension — which all treating clinicians should know. The authors also recommended the development of a female-specific risk score to reflect stroke risk across the lifespan. Dr. Swartz hopes the stroke guidelines will elicit a much broader discussion about the need for research on women’s neurologic health.
“All practicing neurologists need to be more aware of these guidelines and be more proactive with the women in their practices to prevent future strokes. The guidelines help guide prevention and treatment in special populations like women with migraine with aura and pregnant women,” she said.
Dr. Swartz commended the authors of the stroke guidelines for looking at risk factors which are unique for women — like reproductive issues — and things that are more common in women — such as migraine with aura.
“I think we need to look at that in other conditions, too,” she said. “We need to focus on the sexual dimorphism of disease — what are the different risks for the two sexes, why do the differences exist and what are the different outcomes? Do we need to treat them differently?”
In the past, Dr. Swartz explained that the Section was focused largely on important issues of women’s career parity, leadership, and recognizing trauma and abuse. Dr. Swartz, who is an epileptologist at Renown Hospital in Reno, NV, said her training as a basic scientist gave her the idea to use the Section to encourage the study of gender differences throughout neurological disease types. “I thought it would be interesting to start to look at how neurological diseases affect women differently than men. In some areas, like epilepsy, we know quite a bit about that, but in most areas of neurology there hasn’t been as much attention.”
Among her plans for the Section, she hopes to create a registry comprising the Section membership’s research interests and have them perform a review of their particular discipline, “say multiple sclerosis (MS), and how women’s issues affect MS, and how MS may affect women differently than men — and so on.” The registry can also be a platform for more interaction with women or men doing research on women’s neurology across the country so that they may be able to find experts to collaborate with on different projects.
Ultimately, the goal would be to advocate that funding agencies require that grantees properly plan their studies so that they are powered to look at male-female differences, she said. Much of the data that currently exist on gender differences in neurologic disease were not based on “a primary endpoint or even a secondary endpoint to look at male-female differences, so the studies do not have large enough populations to answer these important questions.”
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