Twiddler's Syndrome and Neuromodulation-Devices: A Troubled Marriage.
OBJECTIVE
The occurrence of Twiddler's syndrome in subjects with neurostimulator devices is poorly understood and might be influenced by age, sex, BMI, use of medication or psychologic disorders.


METHODS
Two hundred thiry-five patients who received a neuromodulator were included in this retrospective study in a period between 2008 and 2015. The subjects were divided into a group of Twiddler's syndrome patients (TS) and a group of non-Twiddler's patients (NTS). Outcome measures were gender, age at implantation, type of neuromodulation, use of antipsychotics, antidepressants and opioids, the presence of other psychologic disorders and BMI.


RESULTS
Both groups differ significantly in age (p = 0.024), weight (p = 0.001) and BMI (p = 0.001). No statistical difference was found in the type of neuromodulation (p = 0.537), gender (p = 0.368), the use of antipsychotics (p = 0.071), antidepressants (p = 0.097), and opioids (p = 1). Forward stepwise logistic regression of all variables showed that age of implementation (p = 0.029), the use of antipsychotics (p = 0.022) and BMI (p = 0.001) were statistically significant for predicting Twiddler's syndrome.


CONCLUSIONS
Twiddler's syndrome is an uncommon complication of neuromodulation implantable devices. Younger age, use of antipsychotics, and high BMI are risk factors that can be used to facilitate rapid diagnosis and treatment.
Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, 1090, Belgium.|Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium.
Maarten
M
Moens
Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, 1090, Belgium.
Francky
F
Petit
Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, 1090, Belgium.
Lisa
L
Goudman
Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium.|Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, 1090, Belgium.
Ann
A
De Smedt
Department of Neurology, ZNA Middelheim General Hospital, Antwerp, Belgium.|Department of Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Brussels, Belgium.
Peter
P
Mariën
Pain in Motion International Research Group, www.paininmotion.be.|Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
Kelly
K
Ickmans
Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium.|Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, 1090, Belgium.
Raf
R
Brouns
D000328:Adult; D000368:Aged; D011211:Electric Power Supplies / Q000009:adverse effects; D004868:Equipment Failure; D055111:Failed Back Surgery Syndrome / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000009:adverse effects*; D012189:Retrospective Studies; D062187:Spinal Cord Stimulation / Q000009:adverse effects*
D018377:Neurotransmitter Agents
Hardware failure; intrathecal therapy; neurostimulation; programmable pump; retrospective study; spinal cord stimulation