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Images in Neurology
April 15, 2019

The Deep Brain Stimulation “Twiddler Syndrome”

Author Affiliations
  • 1Department of Neurology, University of Michigan, Ann Arbor
  • 2Department of Neurosurgery, University of Michigan, Ann Arbor
  • 3Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor
JAMA Neurol. 2019;76(5):620. doi:10.1001/jamaneurol.2019.0691

A woman in her late 60s presented with an uncommon complication of deep brain stimulation (DBS) surgery. She received a diagnosis of Parkinson disease at age 60 years after developing a right-hand rest tremor and micrographia. As her disease progressed, she also experienced declining mobility, with slowness of gait and freezing episodes. A rotigotine patch led to an improvement in symptoms, including gait freezing, but she developed intolerable skin irritation. Intolerance to other pharmacological agents, including nausea and vomiting with levodopa and ropinirole at higher doses, prevented optimal medical management of her motor symptoms.