{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:40:24Z","timestamp":1756370424735,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,2,19]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>Twiddler\u2019s syndrome is a rare complication where the leads attached to cardiac pacemakers or deep brain stimulator (DBS) implantable pulse generators (IPG) become twisted from device rotation. The medical lore has traditionally suggested that patients manipulate the device, with \u2018twiddling\u2019 being more common in elderly and obese individuals due to increased loose subcutaneous tissue, which facilitates device rotation.<\/jats:p>\n               <jats:p>This report describes a case of a woman in her late 60s with DBS for Parkinson\u2019s disease who sustained trauma that presumably caused dislodgement of IPG anchoring stitches, leading to rotation of the IPG without manipulation by the patient. It aims to augment the existing literature on this syndrome and suggests that device rotation can occur without deliberate movement by the patient, challenging the conventional understanding of the syndrome\u2019s aetiology. We propose a new name for the syndrome, PETS: <jats:bold>P<\/jats:bold>ulse generator <jats:bold>E<\/jats:bold>lectrode <jats:bold>T<\/jats:bold>wisting <jats:bold>S<\/jats:bold>yndrome, which is more inclusive of its causes.<\/jats:p>","DOI":"10.1136\/bcr-2024-263681","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T02:23:13Z","timestamp":1742955793000},"page":"e263681","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Renaming Twiddler\u2019s syndrome: an argument for change to reflect a diverse set of aetiologies, patients and devices"],"prefix":"10.1136","volume":"18","author":[{"given":"Kalkidan","family":"Yekuno","sequence":"first","affiliation":[{"name":"Neurosurgery, Virginia Mason Medical Center, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donna","family":"Funk","sequence":"additional","affiliation":[{"name":"Virginia Mason Medical Center, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Marsans","sequence":"additional","affiliation":[{"name":"Neurosurgery, Virginia Mason Medical Center, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farrokh","family":"Farrokhi","sequence":"additional","affiliation":[{"name":"Neurosurgery, Virginia Mason Medical Center, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Roberts","sequence":"additional","affiliation":[{"name":"Virginia Mason Medical Center, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"2025082800590325000_18.3.e263681.1","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/ner.12489","article-title":"Twiddler\u2019s Syndrome and Neuromodulation-Devices: A Troubled Marriage","volume":"20","author":"Moens","year":"2017","journal-title":"Neuromodulation"},{"key":"2025082800590325000_18.3.e263681.2","doi-asserted-by":"crossref","first-page":"708481","DOI":"10.3389\/fnhum.2021.708481","article-title":"Implantable Pulse Generators for Deep Brain Stimulation: Challenges, Complications, and Strategies for Practicality and Longevity","volume":"15","author":"Sarica","year":"2021","journal-title":"Front Hum Neurosci"},{"key":"2025082800590325000_18.3.e263681.3","unstructured":"Larson PS , et al . Twiddler syndrome - an overview. ScienceDirect Topics; 2011. Available: https:\/\/www.sciencedirect.com\/topics\/medicine-and-dentistry\/twiddler-syndrome"},{"key":"2025082800590325000_18.3.e263681.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200304103481518"},{"key":"2025082800590325000_18.3.e263681.5","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s13104-015-1818-0","article-title":"The pacemaker-twiddler\u2019s syndrome: an infrequent cause of pacemaker failure","volume":"9","author":"Salahuddin","year":"2016","journal-title":"BMC Res Notes"},{"key":"2025082800590325000_18.3.e263681.6","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.jocn.2010.11.012","article-title":"Twiddler\u2019s syndrome in a patient with a deep brain stimulation device for generalized dystonia","volume":"18","author":"Astradsson","year":"2011","journal-title":"J Clin Neurosci"},{"key":"2025082800590325000_18.3.e263681.7","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1159\/000319039","article-title":"Prevalence of Twiddler\u2019s syndrome as a cause of deep brain stimulation hardware failure","volume":"88","author":"Burdick","year":"2010","journal-title":"Stereotact Funct Neurosurg"},{"key":"2025082800590325000_18.3.e263681.8","unstructured":"Hoque F . Twiddler\u2019s Syndrome: A rare but lethal complication. BMANA J 2022."},{"key":"2025082800590325000_18.3.e263681.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39279.395787.BE"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-263681","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:59:14Z","timestamp":1756367954000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-263681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":9,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,25]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bcr-2024-263681"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-263681","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}