Twiddler syndrome in a patient with tremor dominant Parkinson's disease. A case report and literature review.
Twiddler syndrome in a patient with tremor dominant Parkinson's disease. A case report and literature review.
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患有震颤显性帕金森病的 Twiddler 综合征。
DOI：
10.1016/j.pjnns.2015.10.004
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发表时间：
2015
影响因子：
2.9
通讯作者：
Grażyna Brzuszkiewicz
中科院分区：
文献类型：
--
作者：
Michał Sobstyl;M. Ząbek;W. Górecki;Grażyna Brzuszkiewicz
Twiddler综合征被描述为自发旋转或有意外部操作植入心脏或偶尔深部脑刺激（DBS）装置。我们报告了一例震颤为主的帕金森病（PD）患者的硬件相关并发症，该患者接受了单侧丘脑下核（STN） DBS，随后发展为twiddler综合征。本文描述了该患者的临床过程。建议一些手术上的细微差别可以预防其发生。我们的病例报告表明，旋转综合征发生在DBS患者。DBS硬件阻抗检查，胸部x线平片，或触诊通过IPG上方皮肤的隆起延伸导线，可以正确诊断并随后及时进行手术翻修。我们随后的文献回顾显示，全世界DBS患者中只有10例患者患有捻转综合征。考虑到全世界植入DBS硬件的运动障碍患者的数量，这个数字可能表明该综合征可能未被认识或低估。
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.