The current landscape of sex-based disparities in surgical treatment of essential tremor and Parkinson's disease amidst MRgFUS adoption.
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BACKGROUND: Sex disparities in surgical treatment for movement disorders such as essential Tremor (ET) and Parkinson's disease (PD) are well documented for deep brain stimulation (DBS), but remain less understood in the context of newer, less invasive procedures such as magnetic resonance-guided focused ultrasound (MRgFUS). OBJECTIVE: To examine sex differences in the utilization of deep brain stimulation (DBS) and MRgFUS for ET and PD patients using a large, propensity score-matched cohort. METHODS: Data from over 600,000 ET or PD patients were analyzed from TriNetX (07/2005-06/2025). Propensity score matching balanced male and female cohorts. Hazards of receiving DBS, MRgFUS, or combined surgical treatment were compared by sex using hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: In the ET cohort (N = 279,600), females had a significantly lower likelihood of receiving surgical treatment compared with males (HR=0.56, 95% CI:0.53-0.59, p < 0.001), and the trends were similar for the subgroup receiving MRgFUS (HR=0.38, 95% CI:0.34-0.43, p < 0.001) and DBS (HR=0.61, 95% CI:0.58-0.64, p < 0.001). In the PD cohort (N = 344,314), females similarly exhibited lower likelihood of receiving surgical treatment compared with males (HR=0.68, 95% CI:0.65-0.70, p < 0.001), and the trends were similar for subgroup receiving MRgFUS (HR=0.53, 95% CI:0.42-0.68, p < 0.001) and DBS (HR=0.68, 95% CI:0.65-0.71, p < 0.001. CONCLUSIONS: In this multi-institutional analysis, female patients with ET or PD were significantly less likely to undergo surgical treatment with either DBS or MRgFUS, even after adjusting for demographics and comorbidities. The persistence of this disparity despite the availability of MRgFUS suggests that barriers to surgical care extend beyond procedural invasiveness alone. Addressing these inequities will require targeted, multidisciplinary efforts spanning patient education, referral practices, and health system-level factors.