Mehall, now 65, is one of over 400,000 women<\/a> in the U.S. with Parkinson\u2019s disease (PD). The disease damages the neurons in your brain that make dopamine, causing physical symptoms like tremor, stiffness, and slowness along with nonmotor symptoms like depression, anxiety, and sleep disorders. \u201cYou try to put change in your wallet, and your hands feel like there\u2019s an earthquake,\u201d Mehall says. \u201cYou\u2019re trying to put food on a fork to go in your mouth, and half of the time it lands in your lap.\u201d She was frequently exhausted by noon and struggled to type or use the mouse on her work computer. And she found that levodopa, a drug prescribed for PD that provides extra dopamine to the brain<\/a>, could only do so much to help. \u201cThe meds would take effect, I felt good for about 30 minutes, and then the shaking would come back.\u201d<\/p>\n By September 2019, Mehall was working with a neurologist in the University of Colorado health system. He suggested deep brain stimulation, or DBS: a type of surgical intervention meant to help manage the movement symptoms of Parkinson\u2019s when medication alone isn\u2019t cutting it.<\/p>\n Mehall did the surgery, which makes her a rarity among female PD patients. Data has shown that around 30 percent of PD patients with DBS<\/a> are women. The discrepancy can\u2019t fully be explained by the fact that most Parkinson\u2019s patients are male, either, since 42 percent of the patient population is female. Something else is keeping women from this effective treatment\u2014and experts are just starting to understand why.<\/p>\n How the Procedure Works<\/p>\n Think of DBS as a pacemaker for the brain, says Michael S. Okun, MD<\/a>, a director of the Norman Fixel Institute for Neurological Diseases and a coauthor of The Parkinson\u2019s Plan<\/a>. Once placed in the body, he explains, the device \u201cuses tiny electrical pulses to calm overly active brain circuits, smoothing out neural misfires that drive tremor, stiffness, and slowness.\u201d It doesn\u2019t replace lost dopamine; rather, \u201cDBS helps the brain use remaining dopamine more effectively.\u201d<\/p>\n DBS has been used to treat Parkinson\u2019s for decades, and research continues to show its efficacy at managing several key symptoms<\/a>. \u201cIt can reduce tremor, lessen rigidity, ease slowness, and decrease troublesome dyskinesia [involuntary, uncontrollable movements] triggered by medication,\u201d Dr. Okun says. By extension, patients see a pretty dramatic improvement in quality of life<\/a>\u2014they can eat with a steady hand, or walk without assistance. It also often reduces the amount of medication people need to take, adds Dr. Okun. And the effects are long-lasting: One 2021 study published in the journal Neurology<\/a> found the motor and quality-of-life benefits of DBS can persist even 15 years after a patient\u2019s initial surgery.<\/p>\n To be clear, DBS isn\u2019t the only option for Parkinson\u2019s, says Sneha Mantri, MD<\/a>, a movement disorders specialist and the chief medical officer of the Parkinson\u2019s Foundation. Focused ultrasound of the brain can help with tremor, and medication pumps help deliver levodopa more consistently. But the unique benefit of DBS is that it is personalizable, she says\u2014device settings can be adjusted over time to keep up with symptoms. The stimulation also doesn\u2019t damage brain tissue<\/a>, and the whole device can be removed if a patient ever wants it to. (Meanwhile, focused ultrasound is a one-time, irreversible procedure that comes with the risk of brain lesions<\/a>; medication can only do so much if you don\u2019t respond well to it.)<\/p>\n Are You a Good Candidate?<\/p>\n There are two main issues that can make a patient eligible for DBS, says Dr. Mantri. One is \u201cmotor fluctuation,\u201d she says, meaning that they experience ups and downs with their symptoms while on meds. \u201cThe medicine works, but when they wear off, a person \u2018turns off,\u2019 \u201d or crashes, she says\u2014and symptoms come back with a vengeance. The other criterion is a tremor that doesn\u2019t respond to conventional medications. \u201cAbout one in five people with Parkinson\u2019s disease have a very bothersome tremor that doesn\u2019t respond well to meds, but it does happen to respond well to DBS,\u201d she says.<\/p>\n The journey from eligibility to surgery, however, is an involved one. Doctors have to determine whether the potential risks of the procedure (which include infection, bleeding, or worsening cognitive issues) outweigh the benefits for a particular patient. A patient must undergo multiple tests over the course of several appointments, including imaging to map out their brain, a levodopa on\/off test (where doctors see what symptoms are like before and after taking medication), and cognitive evaluations to rule out dementia and understand your overall brain health.<\/p>\n Once approved, installing DBS typically requires two surgeries. In the first, a surgeon drills a small hole in your skull, then inserts tiny wires with electrodes at the ends, called \u201cleads,\u201d into specific areas of the brain that correspond with movement. In the second (which occurs a few weeks later), the surgeon runs the leads down from your skull, underneath the skin of your neck, to connect them to a battery-powered device inserted in the chest. Once the patient has recovered from the procedures, the device gets activated in the neurologist\u2019s office\u2014delivering electrical signals to the brain to help reduce symptoms. Over time, the neurologist will tweak and adjust the settings as symptoms progress. (Newer \u201cclosed loop\u201d models read brain signals in real time and automatically adjust stimulation, adds Dr. Okun.)<\/p>\n Clearly, getting DBS is not (by a long shot) as simple as filling a prescription. But for patients like Mehall, the results are life-changing. \u201cMy tremor is almost eliminated, and I\u2019m pretty much off all medication,\u201d she says. She\u2019s now able to travel solo, which she attributes entirely to DBS. Her next destination: a Caribbean cruise in the spring. \u201cIt was my Christmas present to myself!\u201d she says.<\/p>\n Why Don\u2019t More Women Get DBS?<\/p>\n Elva Brown, now 63, had initially managed her Parkinson\u2019s with medication and consistent exercise. But 10 years ago, when a hip injury required lots of rehab and downtime, her symptoms increased. \u201cThe worst was bradykinesia, which is a slowness I walk with,\u201d she recalls. \u201cI shuffle like half an inch, can\u2019t pick up my feet. It would take me three to four times as long to get to one spot.\u201d She also had severe anxiety, something completely new to her before her diagnosis.<\/p>\n Yet when her doctor mentioned that she could be a good candidate for DBS, Brown struggled with the decision. \u201cI just wasn\u2019t sure if it was going to work,\u201d she says. \u201cI couldn\u2019t imagine somebody drilling into my brain.\u201d This hesitation is common in female patients, says Michelle Fullard, MD<\/a>, a movement disorders specialist and an associate professor of neurology at the University of Colorado Anschutz. From her earliest days of her medical training, she noticed how it was mostly her male patients who opted into DBS, while women seemed to shy away from it.<\/p>\n The reasons are twofold. First, there are systemic health care issues at play, says Dr. Mantri. \u201cWomen often have a more delayed Parkinson\u2019s diagnosis<\/a>,\u201d she says, because they don\u2019t fit the established Parkinson\u2019s archetype of older white male with motor problems. For example, women often initially experience symptoms like mood changes and lightheadedness that a doctor might dismiss as something else.<\/p>\n Once they are diagnosed, female PD patients are less likely than male patients to see a neurologist or a movement disorders specialist<\/a>\u2014the experts in diagnosing and treating the disease; they often rely on their primary care doctor for symptom management. But even with a neurologist\u2019s care, studies show that women are still less likely to be referred for DBS<\/a> than men. They might be told to try more medication first, says Dr. Okun, even though women tend to have more side effects from meds than men do, or that the surgery is a \u201clast resort.\u201d (He emphasizes that it is not.)<\/p>\n The second reason is more sociological: Women are caregivers, so who\u2019s going to take care of them through the procedure? This could be a big reason why women who get a DBS referral are still less likely to get the surgery<\/a> than a male patient\u2014something that Dr. Fullard has observed in her own research. In a 2024 study published in Movement Disorders Clinical Practice<\/a>, Dr. Fullard and her team interviewed male and female PD patients who underwent DBS to understand how they approached the decision-making process.<\/p>\n \u201cOne of the biggest things we found was that women had this lack of support in the decision-making process, and going through the surgery itself,\u201d Dr. Fullard says. Male patients tended to rely on their spouses to help them gather information, take them to appointments, and care for them afterward. But the women in her study, 44 percent of whom lived alone, often reported having to find help outside the home\u2014a huge hurdle when you\u2019re facing multiple pre-op appointments, recovery from two surgeries, and post-surgery tune-ups at the neurologist\u2019s office. \u201cThat led to either having to wait to get the surgery, or having to cobble together help from family, friends, or resources just to get in for appointments and have support after surgery,\u201d she says. Even women with good networks worried more than men did about overburdening loved ones.<\/p>\n Other research<\/a> has suggested that caregiving duties, whether looking after spouses or wrangling grandchildren (on top of work), make it harder for women to say yes to DBS. The caregiver role also shapes how many women consider the surgery\u2019s risks, says Dr. Fullard. She recalls a patient who agonized for three years. \u201cShe was saying, \u2018If something were to happen to me, who\u2019s going to help take care of my grandkids?\u2019 \u201d<\/p>\n The Power of Storytelling<\/p>\n Brown deliberated over DBS for over two years with her neurologist. While she continued to fear the prospect of brain surgery, videos and testimonials she found online from people who had gotten DBS started to change her mind. \u201cThey\u2019d say how different their lives were afterwards,\u201d she recalls.<\/p>\n Like Brown, many PD patients value<\/a> hearing from other patients to help them understand their treatment options. Dr. Fullard found in her study that women particularly craved the opportunity to talk to other women who had DBS. But with so few women getting the procedure, there aren\u2019t many available to show others the way\u2026which, in turn, may keep putting women off of it. How to break out of this catch-22?<\/p>\n One promising starting point: DBS patient ambassador programs. At the University of Colorado Anschutz, where Dr. Fullard works, many of the women who participated in her study now volunteer to talk to others considering DBS. \u201cWe try to match people up based on gender, living situation, whether or not they are still working,\u201d she says. Other hospitals, like the University of Tennessee Medical Center<\/a> and Beth Israel Deaconess Medical Center<\/a>, have similar programs; DBS device manufacturers<\/a> and nonprofits<\/a> also offer opportunities to connect potential candidates with current DBS patients.<\/p>\n Brown herself has turned into a patient ambassador of sorts. \u201cMy doctor and I partner up quite a bit,\u201d she says. \u201cHe refers patients to me.\u201d She recalls talking to a woman who ended up getting DBS in December 2025. \u201cI told her to think about the outcomes, to listen to her doctor or surgeon, and watch videos of people who have had the surgery. And that her hair will grow back!\u201d<\/p>\n Dr. Fullard has also developed a decision aid<\/a> to help women with Parkinson\u2019s disease feel more supported trying to decide if DBS is right for them. \u201cIt really helps lay out the risks, benefits, trade-offs, and options,\u201d she says. It\u2019s already helping: A pilot study of the tool\u2019s effectiveness, published in February in the Journal of Parkinson\u2019s Disease<\/a>, found that it was considered clear, helpful, and well balanced by most participating patients. Dr. Fullard and her team plan to test the tool in other neurology centers across the country, and translate it into other languages.<\/p>\n
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