| **GENDER DIFFERENCES INNEUROLOGIC AUTOIMMUNE DISEASE**

**Barbara S. Giesser, MDAssociate Professor Clinical NeurologyThe University of Arizona Health Sciences Center**

The immune system functions differently in men and women.Women demonstrate more vigorous immune responses to a variety of stimuli, and are moreprone to develop certain diseases that are believed to have an immune etiology. Much ofthis distinction appears to be related to the most basic biologic distinction between thesexes, i.e., the ability to conceive and bear children. It has long been appreciated thatimmune status in women varies in the pregnant and nonpregnant state, and may have cyclicvariation coincident with different phases of the menstrual cycle as well.

Sex steroids are now known to have a wide range of effectson biologic processes outside of the reproductive system. Nerve cells and immune cellsboth have the capacity to respond to sex hormones, and can in turn influence hormoneproduction. Broadly speaking, male sex hormones appear to have a suppressant effect onimmune function, and may protect against the development of some autoimmune diseases.Female hormones may activate or suppress immune activity.

Two autoimmune neurologic diseases which have a clearfemale preponderance are multiple sclerosis and myasthenia gravis. Not only is there agender bias in numbers of people affected, but disease course and symptom severity appearto be different as well. Additionally, both of these conditions have been shown to haveclinical changes during pregnancy and different phases of the menstrual cycle. Sex hormonemanipulation in animal models of these diseases has been shown to modify disease course.

Several directions for clinical and basic scienceinvestigation in autoimmune neurologic disease are suggested by these observations. Theyinclude quantifying symptom changes in women who report neurologic fluctuations correlatedwith menstrual cycle periodicity, measuring hormone levels in patients as a function ofdisease status, investigating levels of immunologically active substances during differentphases of the menstrual cycle, and manipulating sex steroids as a possible treatmentstrategy for certain neurologic diseases.

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