title: Twiddler's syndrome in a patient with a deep brain stimulation device for generalized dystonia.
abstract: Deep brain stimulation (DBS) is the technique of neurostimulation of deep brain structures for the treatment of conditions such as essential tremor, dystonia, Parkinson's disease and chronic pain syndromes. The procedure uses implanted deep brain stimulation electrodes connected to extension leads and an implantable pulse generator (IPG). Hardware failure related to the DBS procedure is not infrequent, and includes electrode migration and disconnection. We describe a patient who received bilateral globus pallidus internus DBS for dystonia with initially good clinical response, but the device eventually failed. Radiographs showed multiple twisting of the extension leads with disconnection from the brain electrodes and a diagnosis of Twiddler's syndrome was made. Twiddler's syndrome was first described in patients with cardiac pacemakers. Patients with mental disability, elderly and obese patients are at increased risk. Twiddler's syndrome should be suspected whenever there is a failure of the DBS device to relieve symptoms previously responsive to stimulation. Surgical correction is usually required.
authors.affiliation: Department of Neurological Surgery, Oxford Functional Neurosurgery, The John Radcliffe Hospital, West Wing, Headley Way, Headington, Oxford OX39DU, United Kingdom. arnar.astradsson@gmail.com
authors.forename: Arnar
authors.initials: A
authors.lastname: Astradsson
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Schweder
authors.forename: Carole
authors.initials: C
authors.lastname: Joint
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Green
authors.forename: Tipu Z
authors.initials: TZ
authors.lastname: Aziz
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000295:instrumentation*; D004421:Dystonia / Q000628:therapy*; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D006801:Humans; D012086:Reoperation; D013577:Syndrome