Related Experiment Video
Updated: Feb 18, 2026
Protocol for Repetitive Transcranial Magnetic Stimulation with Symptom Provocation to Treat Obsessive-compulsive Disorder
Published on: November 25, 2025
Manipulating an internal pulse generator until twiddler's syndrome in a patient treated with deep brain stimulation
Andrea Franzini1, Rebecca Ranieri2,3, Orsola Gambini2,3
1Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy. andrea.franzini1@hotmail.it.
Background:
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.
Methods:
This syndrome is being reported more frequently in patients treated with deep brain stimulation (DBS).
Results:
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.
Conclusion:
The patient did not have compulsions related to touching objects at admission, thus making it difficult to foresee and prevent TS.
