Manipulating an internal pulse generator until twiddler’s syndrome in a patient treated with deep brain stimulation for obsessive-compulsive disorder

Franzini, Andrea; Ranieri, Rebecca; Gambini, Orsola; Messina, Giuseppe

doi:10.1007/s00701-017-3412-9

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…In two recently published case reports, a correlation has been made between obsessive–compulsive disorder (OCD) and TS, 6 , 7 but in both cases, patients underwent the implant of neurological/brain stimulation devices in order to treat neurological and psychiatric disorders.…”

Section: Discussionmentioning

confidence: 99%

A case series of the twiddler syndrome

Montisci,

Soro,

Demelas

et al. 2023

European Heart Journal - Case Reports

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Background Twiddler Syndrome (TS) is a complication of cardiac implantable electronic devices (CIED) implantation, caused by the deliberate or unconscious manipulation of the device by the patient himself, which results in dislocation of the leads by retraction towards the subcutaneous pocket. Case Summary This report describes two clinical cases that occurred in our center, for which two different solutions were successfully implemented. In the first case a complete removal of the stimulation system was performed and a leadless PM (Medtronic Micra VR) was implanted. In the second case the patient underwent a revision procedure. The pacemaker was disconnected, and the electrodes were debrided, a sub-muscular pocket for the PM was created and at the end of the procedure the pacemaker was anchored to the pectoralis major. Discussion TS is a rare and serious complication of CIED implantation, leading to device malfunctioning and higher risk of infection of the pocket due to multiple re-interventions. In these two cases, different surgical solutions were performed, both resulting to be effective to solve the effects of TS.

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Section: Discussionmentioning

confidence: 99%

A case series of the twiddler syndrome

Montisci,

Soro,

Demelas

et al. 2023

European Heart Journal - Case Reports

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“…In addition, the continuation of IPG movement is the cause of the Twiddler’s syndrome mentioned earlier. The Twiddler’s syndrome was first described in patients with pacemakers and has been occasionally reported in patients with DBS ( Burdick et al, 2010 ; Gelabert-Gonzalez et al, 2010 ; Penn et al, 2012 ; Franzini et al, 2018 ; Jackowiak et al, 2019 ; Adams and Shivkumar, 2020 ). This syndrome occurs because of the manipulation of the IPG within its subcutaneous pocket by the patient, leading to twisting of the extension wires and eventually an extension wire fracture.…”

Section: Discussionmentioning

confidence: 99%

Complications After Deep Brain Stimulation: A 21-Year Experience in 426 Patients

Jung

Chang

Park

et al. 2022

Front. Aging Neurosci.

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BackgroundDeep brain stimulation is an established treatment for movement disorders such as Parkinson’s disease, essential tremor, and dystonia. However, various complications that occur after deep brain stimulation are a major concern for patients and neurosurgeons.ObjectiveThis study aimed to analyze various complications that occur after deep brain stimulation.MethodsWe reviewed the medical records of patients with a movement disorder who underwent bilateral deep brain stimulation between 2000 and 2020. Among them, patients requiring revision surgery were analyzed.ResultsA total of 426 patients underwent bilateral deep brain stimulation for a movement disorder. The primary disease was Parkinson’s disease in 315 patients, followed by dystonia in 71 patients and essential tremor in 40 patients. Twenty-six (6.1%) patients had complications requiring revision surgery; the most common complication was infection (12 patients, 2.8%).ConclusionVarious complications may occur after deep brain stimulation, and patient prognosis should be improved by reducing complications.

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“…The scenario in our third case points to another problem in patients who switch systems. The rechargeable device, in general, is smaller than the non‐rechargeable IPG, and therefore, the existing fibrous pocket is larger and allows accidental or voluntary flipping of the pacemaker possibly facilitating the development of twiddler's syndrome 10 . Patients with obsessive and compulsive behaviors might need particular attention.…”

Section: Discussionmentioning

confidence: 99%

Rechargeable Pacemaker Technology in Deep Brain Stimulation: A Step Forward, But Not for Everyone

Runge

Nagel

Schrader

et al. 2021

Movement Disord Clin Pract

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Manipulating an internal pulse generator until twiddler’s syndrome in a patient treated with deep brain stimulation for obsessive-compulsive disorder

Abstract: The patient did not have compulsions related to touching objects at admission, thus making it difficult to foresee and prevent TS.

Cited by 6 publications

References 14 publications

A case series of the twiddler syndrome

A case series of the twiddler syndrome

Complications After Deep Brain Stimulation: A 21-Year Experience in 426 Patients

Rechargeable Pacemaker Technology in Deep Brain Stimulation: A Step Forward, But Not for Everyone

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