Objective:
The aim of our study was to assess the impact of unilateral Gamma Knife thalamotomy on gait and balance and well as psychological functioning of ET and PD patients.

Background: PD and ET are among most common causes of tremor. Pharmacotherapy is the first line of treatment. It can sometimes be ineffective or have unacceptable side effects. In such cases, surgical treatment is an option. Deep Brain stimulation or thalamotomy are among commonly used methods.

Method: We included 20 consecutive patients with PD (n=10) or with ET (n=10) with pharmacoresistant tremor.  They underwent assessments before (n=20); 12 months (n=20), and 24 months (n=15) after the thalamotomy. Gait and balance analysis included timed “Up and go” test, tandem stance test, tandem pivot test, and walking tandem tests. Stabilometry was performed using TecnoBody Prokin-M-line stabilometric platform with Prokin 3 software and gait was assessed on Zebris treadmill. Psychological assessment included Mini-Mental State Examination, an executive clock drawing task, Tower of London,  Benton Judgment of Line Orientation test, Adverse Childhood Experience, The Wechsler Adult Intelligence Scale, Rey Auditory Verbal Learning Test, Boston Naming Test, and Beck’s Depression Inventory tests were performed. Friedman’s ANOVA and Wilcoxon’s signed-rank test were used to compare the outcomes. Patients with PD were assessed in “ON” and “OFF” dopaminergic treatment state.

Results: There were no serious adverse events related to the procedure reported in our study. Statistical analysis revealed no significant change (p>0.05) in performed psychological tests, as well as no significant deterioration in gait and balance in performed tests in a 2-year follow-up.

Conclusion:
​​​​​We conclude that Gamma Knife thalamotomy does not deteriorate the mood or cognitive functions of the patients treated due to tremor associated with PD or ET in a 2-year follow-up. It may be a safe and efficient way of treating pharmacoresistant tremor for patients who are not qualified for DBS procedure.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessment-of-cognitive-functions-and-gait-in-pd-and-et-patients-with-pharmacoresistant-tremor-treated-with-gamma-knife-thalamotomy/