Sobstyl Michał, Ząbek Mirosław, Górecki Wojciech, Brzuszkiewicz-Kuźmicka Grażyna
Neurosurgical Department of Postgraduate Medical Center, Warsaw, Poland.
Neurosurgical Department of Bródno Regional Hospital, Warsaw, Poland.
Neurol Neurochir Pol. 2015;49(6):467-71. doi: 10.1016/j.pjnns.2015.10.004. Epub 2015 Oct 24.
Twiddler syndrome is described as a spontaneous rotation or intentional external manipulation of implanted cardiac or occasionally deep brain stimulation (DBS) devices. We report this hardware related complication in a patient with tremor dominant Parkinson's disease (PD), who underwent unilateral subthalamic nucleus (STN) DBS and subsequently developed twiddler syndrome. The clinical course of twiddler syndrome in this patient is described. Some surgical nuances which may prevent its occurrence are suggested. Our case report indicates that twiddler syndrome occurs in DBS patients. Impedance check of DBS hardware, plain chest X-ray, or palpation for a knobbly extension lead through the skin above the IPG allows the correct diagnosis and subsequently a prompt surgical revision. Our subsequent literature review revealed only 10 patients with twiddler syndrome in DBS patient population worldwide. This number may suggest that this syndrome may be unrecognized or underreported, given the number of patients with movement disorders implanted with DBS hardware worldwide.
“拧转者综合征”被描述为植入式心脏设备或偶尔的深部脑刺激（DBS）设备的自发旋转或故意外部操作。我们报告了一名以震颤为主型帕金森病（PD）患者出现的这种与硬件相关的并发症，该患者接受了单侧丘脑底核（STN）DBS治疗，随后发生了“拧转者综合征”。描述了该患者“拧转者综合征”的临床过程。提出了一些可能预防其发生的手术细节。我们的病例报告表明“拧转者综合征”会在DBS患者中出现。对DBS硬件进行阻抗检查、胸部X线平片或通过植入式脉冲发生器（IPG）上方皮肤触诊有无鼓起的延长导线，有助于做出正确诊断并随后及时进行手术翻修。我们随后的文献综述显示，在全球范围内的DBS患者群体中，仅有10例“拧转者综合征”患者。鉴于全球范围内植入DBS硬件的运动障碍患者数量，这个数字可能表明该综合征可能未被认识到或报告不足。
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