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

Abstract

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.

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

“…[17914] The most frequent clinical setup is that of early[4] or late[8] clinical recurrence, with or without local pain or tenderness, after a successful primary surgical intervention. The absence of response or abnormal response to stimulation, coupled with altered electrode impedances, particularly in the presence of risk factors and/or evidence of IPG dislocation, should raise the suspicion of a hardware issue, and a radiological study becomes mandatory.…”

Deep brain stimulation (DBS) at the interface of neurology and psychiatry

“…Recent advances in target selection may reduce this latency to days in the case of depression (28). There is a risk of device malfunction (29), and in all cases, neurostimulator replacement may be necessary (30), provided the DBS patient outlives the device (i.e., typically two to five years for device replacement and seven to ten years for rechargeable batteries).…”

Shielded Battery Syndrome: A New Hardware Complication of Deep Brain Stimulation

“…Both our cases are postpubertal girls, in whom relatively higher subcutaneous fat volume may have contributed to the hardware migration. The disproportionally large battery pocket and overt mobility of the Activa RC within the pocket are known to lead to other complications including discomfort due to the pull on the cable and also the Twiddler's syndrome [15] .…”