Fracture of Subthalamic Nucleus Deep Brain Stimulation Hardware as a Result of Compulsive Manipulation: Case Report

Machado, André G.; Hiremath, Girish K.; Salazar, Fortino; Rezai, Ali R.

doi:10.1227/01.neu.0000187566.01731.51

Cited by 51 publications

(26 citation statements)

References 11 publications

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“…Unlike our patient, however, the patient of Geissinger and Neal denied any purposeful manipulation of the IPG. Machado et al [18] also reported a similar DBS patient with trichotillomania who digitally manipulated the postauricular connector, causing it to twist, coil and fracture; however, this phenomenon seemed different than both the case of Geissinger and Neal and our cases. In the case of Machado et al the IPG remained immobile in the subclavicular pocket and hardware failure occurred twice, ultimately compelling removal.…”

Section: Discussioncontrasting

confidence: 55%

Prevalence of Twiddler’s Syndrome as a Cause of Deep Brain Stimulation Hardware Failure

Burdick

Okun

Haq

et al. 2010

Stereotact Funct Neurosurg

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We reviewed our deep brain stimulation patient database to describe hardware complications which resulted from implantable pulse generator mobility, a phenomenon referred to as twiddler’s syndrome. A prospectively collected database of adverse events for all patients operated on at the University of Florida was queried searching for hardware malfunctions. Of 362 total leads implanted in 226 patients since 2002, there were 17 hardware malfunctions. Three of them were due to twiddler’s syndrome, representing 1.3% of patients (3 of 226 patients) and 1.4% of leads (5 of 362 leads). The subjects had characteristic presentations including re-emergence of symptoms, pain along the path of the hardware, abnormal impedances/current drain and radiographic signs of twisting/fracture. In all cases securing the implantable pulse generator within the chest pocket resolved the issue. Twiddler’s syndrome in the population of movement disorder patients treated with deep brain stimulation is an uncommon but important adverse event. It possesses a characteristic presentation and with appropriate diagnostic evaluation it is treatable and future occurrences are preventable.

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Section: Discussioncontrasting

confidence: 55%

Prevalence of Twiddler’s Syndrome as a Cause of Deep Brain Stimulation Hardware Failure

Burdick

Okun

Haq

et al. 2010

Stereotact Funct Neurosurg

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“…Obesity and loose subcutaneous tissue in older patients have already been proposed as potential risk factors [9,12,13] , as has any obsessive compulsive co-morbidity such as trichotillomania [14] .…”

Section: Discussionmentioning

confidence: 99%

A Tremulous Twiddler

Israel

Spivak²

2008

Stereotact Funct Neurosurg

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“…Additionally, patients who wish to conceal the presence of the cable running beneath the skin, may experience a cosmetic burden (Messina et al 2014), even when IPGs are moved to areas where they are more discretely concealed, such as the abdomen or buttocks. Additionally, multiple cables that deliver stimulation to bilateral implants from a single IPG may be subjected to a phenomenon called twiddling (Machado et al 2005), manifesting as an obsessive desire to twist the multiple cables together which often ends in cable breakage. These complications from cable thickness support the idea that novel DBS systems should not include cables housing considerably more wires than existing clinical technology.…”

Section: Experimental Deep Brain Stimulating Electrodesmentioning

confidence: 99%

Fabrication and initial testing of the μDBS: a novel Deep Brain Stimulation electrode with thousands of individually controllable contacts

Willsie

Dorval

2015

Biomed Microdevices

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High frequency electrical stimulation of deep brain structures such as the subthalamic nucleus in Parkinson's disease or thalamus for essential tremor is used clinically to reduce symptom severity. Deep brain stimulation activates neurons in specific brain structures and connection pathways, overriding aberrant neural activity associated with symptoms. While optimal deep brain stimulation might activate a particular neural structure precisely, existing deep brain stimulation can only generate roughly-spherical regions of activation that do not overlap with any target anatomy. Additionally, side effects linked to stimulation may be the result of limited control over placement of stimulation and its subsequent spread out of optimal target boundaries. We propose a novel lead with thousands of individually controllable contacts capable of asymmetric stimulation profiles. Here we outline the design motivation, manufacturing process, and initial testing of this new electrode design, placing it on track for further directional stimulation studies.

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Fracture of Subthalamic Nucleus Deep Brain Stimulation Hardware as a Result of Compulsive Manipulation: Case Report

Cited by 51 publications

References 11 publications

Prevalence of Twiddler’s Syndrome as a Cause of Deep Brain Stimulation Hardware Failure

Prevalence of Twiddler’s Syndrome as a Cause of Deep Brain Stimulation Hardware Failure

A Tremulous Twiddler

Fabrication and initial testing of the μDBS: a novel Deep Brain Stimulation electrode with thousands of individually controllable contacts

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