A systematic review of Twiddler’s syndrome: a hardware-related complication of deep brain stimulation

Liu, Xiaowei; Xu, Yangyang; Bergman, Hagai; Li, Siyu; Wang, Wei

doi:10.1007/s10143-021-01636-9

Cited by 5 publications

(4 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 11 ] Twiddler’s syndrome has been reported in 1.3% of patients with movement disorders, and DBS leads were the cause in 1.4% of reported cases. [ 4 , 10 , 13 ] Twiddler’s syndrome has been well described in the cardiac literature for many decades, especially in patients with pacemakers and implantable cardioverter-defibrillators. [ 3 ] It occurs when the IPG moves within an overly large pocket.…”

Section: Discussionmentioning

confidence: 99%

“…Twiddler’s syndrome is a rare complication that occurs in patients undergoing neuromodulation with an implanted pacemaker or defibrillator[ 3 ] and causes hardware failure in about 1% of cases. [ 10 ] Twiddler’s syndrome was first reported in 1968 to implantable cardiac devices[ 3 ] and has since emerged as a known side effect of other implantable devices, such as those used in spinal cord stimulation systems and DBS systems. [ 4 ] The syndrome develops as a result of the patient’s intentional or unintentional movement of the device, which causes it to rotate in the pocket, create torsion, and dislodge the implanted lead.…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 ] The syndrome develops as a result of the patient’s intentional or unintentional movement of the device, which causes it to rotate in the pocket, create torsion, and dislodge the implanted lead. [ 10 ] In this report, we describe a case of subclinical cable twisting jeopardizing Twiddler’s syndrome in a patient with Parkinson’s disease who was undergoing DBS targeting the right globus pallidus internus (GPI). This report adds to the limited literature on Twiddler’s syndrome in patients with Parkinson’s disease following DBS implantation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Asymptomatic cable twisting in a patient with impending Twiddler syndrome detected during deep brain stimulation surgery for Parkinson’s disease: A case report

Permana,

Morishita,

Tanaka

et al. 2024

Surgical Neurology International

View full text Add to dashboard Cite

Background: Deep brain stimulation (DBS) has consistently demonstrated high efficacy and safety in patients with Parkinson’s disease. Twiddler’s syndrome is a rare occurrence of hardware failure in patients undergoing neuromodulation. We report here a case of subclinical cable twisting jeopardizing Twiddler’s syndrome in a patient with Parkinson’s disease who underwent DBS surgery targeting the globus pallidus internus (GPI). Case Description: A 70-year-old woman with a 7-year history of Parkinson’s disease refractory to medication was referred to our department for treatment of involuntary movements of the left hand and leg. She underwent right GPI DBS implantation. Left GPI DBS implantation was subsequently planned to manage resting tremors that developed in the right leg after the first surgery at around one year after the first surgery. During a routine check-up before the second surgery, we incidentally detected Twiddler’s syndrome. The patient showed no neurological deficits in the left extremities, the same as before right GPI DBS. We performed left GPI DBS concomitantly with the revision of the implantable pulse generator and extension wire. Conclusion: Twiddler’s syndrome is a rare complication of DBS. Subclinical risk of cable twisting jeopardizing Twiddler’s syndrome is rarely detected without clinical indications of hardware failure. Neurosurgeons should be cognizant of and regularly monitor the implanted device in case serious complications occur.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Asymptomatic cable twisting in a patient with impending Twiddler syndrome detected during deep brain stimulation surgery for Parkinson’s disease: A case report

Permana,

Morishita,

Tanaka

et al. 2024

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…Effective maneuvers include skull drilling to recess the burr hole cover and the lead extension connectors to make them flush with the outer table of the skull and deep implantation of the pulse generator with minimal tension on the wound closure. Short and open circuits can occur after any procedure, are commonly due to iatrogenic damage to hardware during implantation, and occasionally due to patient behavior such as "twiddling" [79]. Fortunately, newer hardware models are more robust, and less susceptible to damage.…”

Section: Dbs-related Complicationsmentioning

confidence: 99%