Twiddler’s Syndrome and Neuromodulation-Devices: A Troubled Marriage

Moens, Maarten; Petit, Francky; Goudman, Lisa; Smedt, Ann De; Mariën, Peter; Ickmans, Kelly; Brouns, Raf

doi:10.1111/ner.12489

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…5,6 Patients typically present with early or late reemergence of symptoms, which can be accompanied by wound complications, localized pain, and tenderness of the lead tract, as well as elevated impedance recordings on routine follow-up. 1,2,[5][6][7] Diagnosis is usually made with plain radiographs. Imaging of the brain should be considered, as severe cases can result in intracranial electrode retraction.…”

mentioning

confidence: 99%

What’s the Twist? Twiddler’s Syndrome in Deep Brain Stimulation

Vitali

2017

Can. J. Neurol. Sci.

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confidence: 99%

What’s the Twist? Twiddler’s Syndrome in Deep Brain Stimulation

Vitali

2017

Can. J. Neurol. Sci.

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Section: Discussionmentioning

confidence: 99%

“…In addition to the intraoperative challenge that is faced with securing the IPG to overweight patients, the presence of relaxed/loose tissue facilitates the rotation of the pacemaker, predisposing obese and elderly patients to the Twiddler's syndrome [11,12]. Studies also show a predisposition of younger patients, with increased mobility and ability to perform repetitive movements, to have unintended twisting of the leads [12]. Patients with psychiatric disorders, such as dementia, anxiety, obsessive-compulsive tendencies, or paranoia, are also predisposed to the Twiddler's syndrome; however, due to the rarity of this complication, an incidence rate is difficult to determine [1,13].…”

Section: Discussionmentioning

confidence: 99%

The Unsuccessful Twiddler: A Case of Twiddler's Syndrome Without Deep Brain Stimulator Lead Breakage

Ghanchi

Taka

Bernstein

et al. 2020

Cureus

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The authors present the case of a 78-year-old right-handed female with a past medical history of Parkinson's disease, treated with implantation of a left-sided subthalamic nucleus St. Jude Medical Infinity® (Abbott Medical, Austin, TX) deep brain stimulator, who presented with leadassociated discomfort, or "bowstringing". Further investigation by chest X-ray revealed an extensive case of distal lead coiling. However, it was surprising that, despite the extensive coiling, the lead stayed intact without hardware failure as proven by patient remaining asymptomatic from her Parkinson's disease and intraoperative impedance testing demonstrating normal results. After revision surgery, the patient remained asymptomatic. Due to paucity of cases of this disease in the literature, specific predictive risk factors are not known, but certain patient characteristics may help take precautions.

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“…Multiple risk factors for twiddler's syndrome have been proposed including obesity, advanced age, female gender, and psychological disorders. A recent study analyzed these variables and was able to identify high body mass index (BMI) and antipsychotic medication use as risk factors 3 . A prevalence towards twiddler's syndrome in younger patients was noted.…”

Section: Discussionmentioning

confidence: 99%

“…First described as a rare cause of pacemaker failure, twiddler's syndrome has now been documented with other implantable devices including spinal cord stimulators, intraspinal drug delivery devices, deep brain stimulators, and vagal nerve stimulators 3 . The incidence of twiddler's syndrome as a cause of implantable device failure has been estimated to be as high as 4.7% 3 .…”

Section: Discussionmentioning

confidence: 99%