Objective: To assess the efficacy of physiotherapy with fall prevention instructions in patients with refractory ET who underwent unilateral MRgFUS thalamotomy.

Background: unilateral MRgFUS thalamotomy targeting the ventral intermediate nucleus (VIM) of the thalamus can improve tremor in patients with medically refractory ET [1]. The procedure can cause transient or permanent side effects including ataxia of gait which can cause falls. Transient gait ataxia can result in long lasting  side effects due to falls such as fractures and head trauma. Multiple‐component exercise was shown to significantly reduced rate of falls in the elderly population [2].

Method: Data was collected for all refractory ET patients who underwent unilateral MRgFUS thalamotomy in Sheba medical center and had a follow up period of at least 1 month. Data included demographic data, occurrence of falls and information regarding physical therapy with instructions for fall prevention and assessing fall risk.

Results: Data was retrospectively collected of 48 patients. Out of 27 patients who had no physiotherapy with fall prevention instructions 4 patients experienced falls in the months following the MRgFUS thalamotomy. The other 21 received perioperative physiotherapy with fall prevention instructions and none of them had any falls post operation. This difference in falls was not statistically significant (P value = 0.138).
The 4 patients who fell were significantly older than the rest of the patients- 75.25  years and 72.77 years  respectively (P<0.001) and had a shorter disease duration 18 years and 23.4 years respectively (P<0.001).

Conclusion: Gait ataxia following MRgFUS thalamotomy may be transient, but it can still cause falls which can result in injury. Our results show no falls in the group that received fall prevention instruction and 4 patients who fell postoperitavely in the group that did not receive treatment, however due to the small numbers this difference was not statistically significant. We believe physiotherapy with fall prevention instructions can help reduce the risk of falls as it was shown to reduce that risk in the elderly population [2] and should be applied to patients prior to MRgFUS thalamotomy ,especially in older patients which are more prone to falls. Further research should be conducted to assess the efficacy.

References: [1] Elias WJ, Lipsman N, Ondo WG, et al. A Randomized Trial of Focused Ultrasound
Thalamotomy for Essential Tremor. N Engl J Med 2016;375:730-739.
[2] Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson L, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane

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MDS Abstracts - https://www.mdsabstracts.org/abstract/fall-prevention-in-patients-undergoing-magnetic-resonance-guided-focused-ultrasound-thalamotomy-mrgfus-thalamotomy-for-refractory-essential-tremor-et/