Obsessive Compulsive Disorder in a Patient with Twiddler's Syndrome

Abstract

Twiddler's or twist syndrome is the twisting of pulse generators around themselves. It may result from mechanical manipulation that can induce the malfunction of the device. In this case, twiddler's syndrome resulted from compulsive checking of the device. The implantable cardioverter-defibrillator (ICD) triggered the development of an obsessive compulsive disorder (OCD). Two invasive procedures were required to replace the ICD. Psychiatric intervention prevented the recurrence of twiddler's syndrome in this patient for more than 2 years. We believe that preimplant psychiatric assessment should be the rule.

Twiddler (or Not) Syndrome: Questioning etiology for an uncommon form of hardware malfunction in deep brain stimulation

“…A history of psychiatric disease (namely obsessive-compulsive disorder[12]), obesity, and higher age were described as risk factors. [1] Only recently has this entity been transposed to the neurosurgical field.…”

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

“…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]. Similar to the case we present, it is often noticed that patients deny twisting the device despite the presence of extensive coiling that is very unlikely to have occurred spontaneously.…”

“…Postoperative pain in the place of surgery can trigger an automatic reflex of manipulating the IPG in an effort to relieve the pain, which could be counteracted by the patients' understanding of their treatment and possible complications [13]. For this reason, it is important to educate patients regarding their condition as a preventative measure against twiddling.…”

Erosive Twiddler’s Syndrome: A Severe Case with Externalization of the Pacemaker

“…When treating patients with TS, it is important to evaluate for psychiatric conditions, as many correlations have been documented with OCD and other picking disorders [16,17]. Implantable device shape should be considered, as elongated devices have been linked with spontaneous rotation [18].…”