Prevalence of twiddler's syndrome as a cause of deep brain stimulation hardware failure

Adam P. Burdick, Michael S. Okun, Ihtsham U. Haq, Herbert E. Ward, Frank Bova, Charles E. Jacobson, Dawn Bowers, Pam Zeilman, Kelly D. Foote

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


We reviewed our deep brain stimulation patient database to describe hardware complications which resulted from implantable pulse generator mobility, a phenomenon referred to as twiddler's syndrome. A prospectively collected database of adverse events for all patients operated on at the University of Florida was queried searching for hardware malfunctions. Of 362 total leads implanted in 226 patients since 2002, there were 17 hardware malfunctions. Three of them were due to twiddler's syndrome, representing 1.3% of patients (3 of 226 patients) and 1.4% of leads (5 of 362 leads). The subjects had characteristic presentations including re-emergence of symptoms, pain along the path of the hardware, abnormal impedances/current drain and radiographic signs of twisting/fracture. In all cases securing the implantable pulse generator within the chest pocket resolved the issue. Twiddler's syndrome in the population of movement disorder patients treated with deep brain stimulation is an uncommon but important adverse event. It possesses a characteristic presentation and with appropriate diagnostic evaluation it is treatable and future occurrences are preventable.

Original languageEnglish (US)
Pages (from-to)353-359
Number of pages7
JournalStereotactic and Functional Neurosurgery
Issue number6
StatePublished - Nov 2010
Externally publishedYes


  • Adverse event
  • Complication
  • Deep brain stimulation
  • Twiddler's syndrome

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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