Manipulating an internal pulse generator until twiddler's syndrome in a patient treated with deep brain stimulation for obsessive-compulsive disorder.

Abstract

Twiddler's syndrome consists of rotation or manipulation of an implantable pulse generator (IPG) in its subcutaneous pocket by a patient, thus causing hardware malfunction. This syndrome is being reported more frequently in patients treated with deep brain stimulation (DBS). We report the case of a woman who had received bed nucleus of stria terminalis (BNST) electrodes for obsessive-compulsive disorder (OCD) and developed twiddler's syndrome a few months after surgery, causing hardware malfunction due to obsessive manipulation of the IPG. The patient did not have compulsions related to touching objects at admission, thus making it difficult to foresee and prevent TS.