Geissinger Gregory, Neal John H
Department of Neurosurgery, Marshfield Clinic, Marshfield, WI 54449, USA.
Surg Neurol. 2007 Oct;68(4):454-6; discussion 456. doi: 10.1016/j.surneu.2006.10.062. Epub 2007 Jun 4.
The subcutaneous placement of IPGs with electrodes to various intracranial and extracranial sites for the purpose of controlling conditions such as essential tremor, epilepsy, Parkinson's disease, and pain is increasing. Experience with similar placement of cardiac pacemakers and defibrillators had revealed the possibility of generator migration and subsequent lead fracture either spontaneously or, more often, through a patient's conscious or subconscious manipulation of the device through the skin. This phenomenon has been termed twiddler's syndrome.
An elderly patient's IPG used in the treatment of a debilitating essential tremor had spontaneously rotated during the course of normal physical activities. This resulted in the twisting and fracturing of the leads. Torsional displacement of and tissue stress on subauricular lead connectors caused early discomfort in that region. Recurrent tremors occurred upon device failure. Surgical replacement of the IPG lead and use of a polyester pouch sutured to the surrounding fascia were observed to correct the problem.
Those caring for patients, especially elderly and obese patients, with an IPG should be aware of the potential of device failure as a result of spontaneous twiddler's syndrome.
为控制诸如特发性震颤、癫痫、帕金森病和疼痛等病症，将植入式脉冲发生器（IPG）皮下放置并连接电极至各种颅内和颅外部位的情况日益增多。心脏起搏器和除颤器类似放置的经验已揭示发生器迁移以及随后导线断裂的可能性，这种情况可能自发发生，或者更常见的是，患者通过皮肤有意识或下意识地操作设备导致。这种现象被称为“摆弄者综合征”。
一名老年患者用于治疗严重特发性震颤的IPG在正常身体活动过程中自发旋转。这导致导线扭曲和断裂。耳下导线连接器的扭转移位和组织应力在该区域引起早期不适。设备故障时出现反复震颤。观察到通过手术更换IPG导线并使用缝合至周围筋膜的聚酯袋可纠正该问题。
照顾植入IPG的患者，尤其是老年和肥胖患者的人员，应意识到自发“摆弄者综合征”导致设备故障的可能性。
