Twiddler’s Syndrome in a Patient with Dystonic Tremor Treated with DBS
Affiliation(s)
1 Department of Neurosurgery, Umea University Hospital, Umea, Sweden. 2 Department of Neurosurgery, Umea University, Umea, Sweden.
1 Department of Neurosurgery, Umea University Hospital, Umea, Sweden. 2 Department of Neurosurgery, Umea University, Umea, Sweden.
ABSTRACT
Background and Importance: Twiddler’s syndrome is a rare complication of DBS. This condition occurs when the IPG is consciously or inadvertently rotated in its pocket, resulting in torsion and possible dislodgement of implanted electrodes, with subsequent loss of function. Methods: Here we present a patient diagnosed with Twiddler’s syndrome. The patient presented with straining cables at the neck five months after bilateral Gpi DBS and an x-ray demonstrated Twiddler’s syndrome. Initial revision with preventive measures proved futile. After some time the condition recurred, now with dislocation of one of the intracerebral electrodes. In a second revision the IPG was placed under the pectoralis muscle, which has so far prevented further rotation. Results and Conclusion: While Twiddler’s syndrome is fairly uncommon, it remains to be a risk associated with DBS, recognizing the potential risks and signs might allow for preventive measures avoiding dislocation of the intracerebral electrodes.
Background and Importance: Twiddler’s syndrome is a rare complication of DBS. This condition occurs when the IPG is consciously or inadvertently rotated in its pocket, resulting in torsion and possible dislodgement of implanted electrodes, with subsequent loss of function. Methods: Here we present a patient diagnosed with Twiddler’s syndrome. The patient presented with straining cables at the neck five months after bilateral Gpi DBS and an x-ray demonstrated Twiddler’s syndrome. Initial revision with preventive measures proved futile. After some time the condition recurred, now with dislocation of one of the intracerebral electrodes. In a second revision the IPG was placed under the pectoralis muscle, which has so far prevented further rotation. Results and Conclusion: While Twiddler’s syndrome is fairly uncommon, it remains to be a risk associated with DBS, recognizing the potential risks and signs might allow for preventive measures avoiding dislocation of the intracerebral electrodes.
Cite this paper
Samuelsson, J. and Blomstedt, P. (2014) Twiddler’s Syndrome in a Patient with Dystonic Tremor Treated with DBS. Open Journal of Modern Neurosurgery, 4, 193-195. doi: 10.4236/ojmn.2014.44034.
Samuelsson, J. and Blomstedt, P. (2014) Twiddler’s Syndrome in a Patient with Dystonic Tremor Treated with DBS. Open Journal of Modern Neurosurgery, 4, 193-195. doi: 10.4236/ojmn.2014.44034.
References
[1] Fahraeus, T. and Hijer, C.J. (2003) Early Pacemaker Twiddler Syndrome. Europace, 5, 279-281.
http://dx.doi.org/10.1016/S1099-5129(03)00032-1 [2] Astradsson, A., Schweder, P.M., Joint, C., et al. (2011) Twiddler’s Syndrome in a Patient with a Deep Brain Stimulation Device for Generalized Dystonia. Journal of Clinical Neuroscience, 18, 970-972.
http://dx.doi.org/10.1016/j.jocn.2010.11.012 [3] Geissinger, G. and Neal, J.H. (2007) Spontaneous Twiddler’s Syndrome in a Patient with a Deep Brain Stimulator. Surgical Neurology, 68, 454-456.
http://dx.doi.org/10.1016/j.surneu.2006.10.062 [4] Gelabert-Gonzalez, M., Relova-Quinteiro, J.L. and Castro-Garcia, A. (2010) “Twiddler’s Syndrome” in Two Patients with Deep Brain Stimulation. Acta Neurochirurgica (Wien), 152, 489-491.
http://dx.doi.org/10.1007/s00701-009-0366-6
[1] Fahraeus, T. and Hijer, C.J. (2003) Early Pacemaker Twiddler Syndrome. Europace, 5, 279-281.
http://dx.doi.org/10.1016/S1099-5129(03)00032-1 [2] Astradsson, A., Schweder, P.M., Joint, C., et al. (2011) Twiddler’s Syndrome in a Patient with a Deep Brain Stimulation Device for Generalized Dystonia. Journal of Clinical Neuroscience, 18, 970-972.
http://dx.doi.org/10.1016/j.jocn.2010.11.012 [3] Geissinger, G. and Neal, J.H. (2007) Spontaneous Twiddler’s Syndrome in a Patient with a Deep Brain Stimulator. Surgical Neurology, 68, 454-456.
http://dx.doi.org/10.1016/j.surneu.2006.10.062 [4] Gelabert-Gonzalez, M., Relova-Quinteiro, J.L. and Castro-Garcia, A. (2010) “Twiddler’s Syndrome” in Two Patients with Deep Brain Stimulation. Acta Neurochirurgica (Wien), 152, 489-491.
http://dx.doi.org/10.1007/s00701-009-0366-6