Twiddler syndrome as a cause of defibrillator malfunction

BackgroundThe aims are to present a case series of Twiddler’s syndrome in spinal cord stimulators with analysis of the possible mechanism of this syndrome and discuss how this phenomenon can be prevented.MethodData were collected retrospectively between 2007 and 2013 for all patients presenting with failure of spinal cord stimulators. The diagnostic criterion for Twiddler’s syndrome is radiological evidence of twisting of wires in the presence of failure of spinal cord stimulation.ResultsOur unit implants on average 110 spinal cord stimulators a year. Over the 5-year study period, all consecutive cases of spinal cord stimulation failure were studied. Three patients with Twiddler’s syndrome were identified. Presentation ranged from 4 to 228 weeks after implantation. Imaging revealed repeated rotations and twisting of the wires of the spinal cord stimulators leading to hardware failure.ConclusionsTo the best of our knowledge this is the first reported series of Twiddler’s syndrome with implantable pulse generators (IPGs) for spinal cord stimulation. Hardware failure is not uncommon in spinal cord stimulation. Awareness and identification of Twiddler’s syndrome may help prevent its occurrence and further revisions. This may be achieved by implanting the IPG in the lumbar region subcutaneously above the belt line. Psychological intervention may have a preventative role for those who are deemed at high risk of Twiddler’s syndrome from initial psychological screening.

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Twiddler’s syndrome in spinal cord stimulation

Al-Mahfoudh

Chan

Chong

et al. 2015

Acta Neurochir

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A case of twitching on the pacemaker pocket

Kalaycı

Akgün

et al. 2017

International Journal of the Cardiovascular Academy

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An atypical manifestation of Twiddler syndrome

Dattilo

Scarano²,

Casale

et al. 2015

International Journal of Cardiology

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Twiddler syndrome as a cause of defibrillator malfunction

Cited by 5 publications

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Twiddler’s syndrome in spinal cord stimulation

Twiddler’s syndrome in spinal cord stimulation

A case of twitching on the pacemaker pocket

An atypical manifestation of Twiddler syndrome

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