Objective: Twiddler syndrome is one of the major complications in DBS treatment.
 

Background: The patient intentionally and subconsciously spins internal pulse generator Spinning generally causes open circuit as a result of extension cable fracture or even displacement of the lead. 

Methods: A 72-year-old female with ten years history of Parkinson’s disease (PD) with motor complications underwent bilateral STN-DBS surgery in June 2014. Her PD symptoms were under control over a two-year period. In June 2016, she admitted with complaints of sudden worsening in gait, severe bradykinesia and dystonic pain on the right side of the trunk; same as her preoperative period complaints. Examination of DBS hardware revealed a connection problem of internal pulse generator (IPG) with open circuit. Plain anteroposterior chest and skull X-ray of the patient showed coiled extension leads and evident disconnection between electrode lead connections and extension leads  [Figure1] [Figure 2]. The patient was diagnosed with twiddler syndrome with no evidence of impulse control disorder. Her medical history and neuropsychiatric tests were normal.

Results: The patient underwent an IPG revision surgery [figure3]. After revision surgery, symptoms improved to the level as those achieved from her previous surgery. To prevent the recurrence of twiddling the patient was held in observation status for two days. After discharge she was under the observation of her primary caregiver. At the end of one month there was no recurrence and her clinical condition was stabilized.

Conclusions: Twiddler syndrome is a rare but troubling complication of DBS, causing connection problems of the hardware. It is usually associated with impulsivity. In patients with complaints of sudden worsening and high impedance of neurostimulator, twiddler syndrome might be kept in mind, even without any impulsivity.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/twiddler-syndrome-in-deep-brain-stimulation/