Silent Twiddler syndrome despite dual-anchor fixation in deep brain stimulation

• Twiddler syndrome (TS) is a rare hardware-related complication in which manipulation or excessive mobility of an implanted pacemaker or implantable pulse generator (IPG) causes device malfunction.¹
• TS has traditionally been diagnosed only after lead coiling, fracture, displacement, or loss of therapeutic efficacy, which frames it as a late-stage finding.¹
• A Frontiers in Neuroscience report describes two deep brain stimulation (DBS) patients with Silent Twiddler syndrome.¹
• Both cases involved Twiddler-like IPG mobility despite dual-anchor fixation of the implanted hardware.¹
• The presentations occurred before classic lead failure signs such as coiling, fracture, displacement, or loss of therapeutic effect.¹
• The authors characterize this earlier IPG mobility pattern as a silent form of Twiddler syndrome in DBS systems.^{1 1}

Footnotes

1. https://www.frontiersin.org/articles/10.3389/fnins.2026.1885621 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷