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Twiddler syndrome in a patient with tremor dominant Parkinson's disease. A case report and literature review
- Neurosurgical Department of Postgraduate Medical Center, Warsaw, Poland
- Neurosurgical Department of Bródno Regional Hospital, Warsaw, Poland
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka 34,, 00-968 Warszawa 45 Warsaw, Poland
open access
Abstract
Twiddler syndrome is described as a spontaneous rotation or intentional external manipulation of implanted cardiac or occasionally deep brain stimulation (DBS) devices. We report this hardware related complication in a patient with tremor dominant Parkinson's disease (PD), who underwent unilateral subthalamic nucleus (STN) DBS and subsequently developed twiddler syndrome. The clinical course of twiddler syndrome in this patient is described. Some surgical nuances which may prevent its occurrence are suggested. Our case report indicates that twiddler syndrome occurs in DBS patients. Impedance check of DBS hardware, plain chest X-ray, or palpation for a knobbly extension lead through the skin above the IPG allows the correct diagnosis and subsequently a prompt surgical revision. Our subsequent literature review revealed only 10 patients with twiddler syndrome in DBS patient population worldwide. This number may suggest that this syndrome may be unrecognized or underreported, given the number of patients with movement disorders implanted with DBS hardware worldwide.
Abstract
Twiddler syndrome is described as a spontaneous rotation or intentional external manipulation of implanted cardiac or occasionally deep brain stimulation (DBS) devices. We report this hardware related complication in a patient with tremor dominant Parkinson's disease (PD), who underwent unilateral subthalamic nucleus (STN) DBS and subsequently developed twiddler syndrome. The clinical course of twiddler syndrome in this patient is described. Some surgical nuances which may prevent its occurrence are suggested. Our case report indicates that twiddler syndrome occurs in DBS patients. Impedance check of DBS hardware, plain chest X-ray, or palpation for a knobbly extension lead through the skin above the IPG allows the correct diagnosis and subsequently a prompt surgical revision. Our subsequent literature review revealed only 10 patients with twiddler syndrome in DBS patient population worldwide. This number may suggest that this syndrome may be unrecognized or underreported, given the number of patients with movement disorders implanted with DBS hardware worldwide.
Keywords
Twiddler syndrome, Deep brain stimulation, Hardware complication, Parkinson' s disease
Title
Twiddler syndrome in a patient with tremor dominant Parkinson's disease. A case report and literature review
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
467-471
Page views
232
Article views/downloads
408
DOI
10.1016/j.pjnns.2015.10.004
Bibliographic record
Neurol Neurochir Pol 2015;49(6):467-471.
Keywords
Twiddler syndrome
Deep brain stimulation
Hardware complication
Parkinson's disease
Authors
Michał Sobstyl
Mirosław Ząbek
Wojciech Górecki
Grażyna Brzuszkiewicz-Kuźmicka