Objective: To discuss whether brittle dyskinesia can be a cause of Twiddler syndrome.

Background: Many studies have reported that the cause of Twiddler syndrome ( TS ) is impulsivity. TS has also been reported to develop in some of the cases without impulsivity. In this patient group brittle may be the cause of dyskinesia TS.

Methods: Case Report.

Results: A 57 year-old female with Parkinson’s disease (PD) with motor complications underwent bilateral STN-DBS in August of 2017. The patient who had no complications, opened the neurostimulator one week after the operation. Excellent clinical response was obtained in the patient after programming. But after the last programming, insistent dyskinesias developed on the left side where the battery was present. Because of the weekend holiday, reprogramming could not be done. The patient was contacted by phone and the dose of the patient’s dopaminergic treatment was reduced. Although the entire treatment of the patient was interrupted, the dyskinesia did not fully decrease. Dyskinesia was controlled by reducing the power of stimulation and changing the contact. Despite no dopaminergic treatment, the patient’s parkinsonian findings disappeared. One day after programming, the patient’s parkinsonian findings reappeared and became worse. Electrode impedance measurements, impedance values were observed to increase every day ( 960, 1120, 2000, 21000 ohm ). Plain anteroposterior chest and skull X-ray of the patient showed coiled extension leads. The patient was diagnosed with TS. She hasn’t got any impuls control problems and attempt to spining battery. The patient underwent an IPG revision surgery. After revision surgery, the patient’s clinical condition improved.

Conclusions: TS is usually associated with impulsivity. But brittle diskinesia may be the cause TS.

References: 1. Baizabal Carvallo JF, Mostile G, Almaguer M, Davidson A, Simpson R, Jankovic J. Deep brain stimulation hardware complications in patients with movement disorders: Risk factors and clinical correlations. Stereotact Funct Neurosurg. 2012;90:300–6. 2.Geissinger G, Neal JH. Spontaneous twiddler’s syndrome in a patient with a deep brain stimulator. Surg Neurol. 2007;68:454–6.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/can-brittle-dyskinesia-be-one-of-the-causes-of-twiddler-syndrome-in-deep-brain-stimulation/