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

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.