Objective: We aimed to describe specific features of gait disorders and postural instability in patients with severe essential tremor (ET), and to evaluate the effect on motor skills of unilateral Gamma Knife Thalamotomy (GKT).

Background: ET is characterized by a progressive postural and kinetic tremor affecting the arms, responsible for a functional impairment in daily activities. Despite its high frequency, ET pathophysiology remains poorly understood and therapeutic options are limited. Some clinical and experimental data suggest a cerebellar involvement in this affection, however few data about the existence of gait and posture disorders in ET are available.

Methods: 50 patients with severe refractory ET underwent unilateral GKT. Their mean age was 73 years. Targeting of the ventral intermediate nucleus (Vim) was achieved with Leksell Gamma Knife with a single shot through a 4-mm collimator helmet. The prescription dose was 130 Gy. Severity of ET (Fahn-Tolosa-Marin Tremor Rating Scale), cognitive function, activities of daily living (Bain’s functional scale), gait and postural control were assessed before and 1 year after radiosurgery. Gait and postural control were also recorded in 16 healthy elderly adults.

Results: The comparison between ET patients before surgery and control subjects showed poorer posturo-locomotor skills in the patients group. All tremor components (rest, postural, and intention) of the rating scale and activities of daily living were improved after GKT. Cognitive functions like gait and postural control remained unchanged after GKT.

Conclusions: This study showed postural instability and gait impairment in ET, which may be related to a dysfunction of cerebello-thalamo-cortical pathway. Moreover, our work showed no deleterious effect of unilateral GKT on posture and gait skills. The unilateral and progressive nature of GKT could explain the absence of degradation of gait and posture. Unilateral GKT is a safe and efficient procedure for severe medically refractory tremor.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/no-deleterious-effect-of-unilateral-gamma-knife-thalamotomy-on-gait-and-posture-in-patients-with-essential-tremor/