• Maarten Moens, Francky Petit, Lisa Goudman, Ann De Smedt, Peter Mariën, Kelly Ickmans, and Raf Brouns.
• Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, 1090, Belgium.
• Neuromodulation. 2017 Apr 1; 20 (3): 279-283.

ObjectiveThe occurrence of Twiddler's syndrome in subjects with neurostimulator devices is poorly understood and might be influenced by age, sex, BMI, use of medication or psychologic disorders.MethodsTwo hundred thiry-five patients who received a neuromodulator were included in this retrospective study in a period between 2008 and 2015. The subjects were divided into a group of Twiddler's syndrome patients (TS) and a group of non-Twiddler's patients (NTS). Outcome measures were gender, age at implantation, type of neuromodulation, use of antipsychotics, antidepressants and opioids, the presence of other psychologic disorders and BMI.ResultsBoth groups differ significantly in age (p = 0.024), weight (p = 0.001) and BMI (p = 0.001). No statistical difference was found in the type of neuromodulation (p = 0.537), gender (p = 0.368), the use of antipsychotics (p = 0.071), antidepressants (p = 0.097), and opioids (p = 1). Forward stepwise logistic regression of all variables showed that age of implementation (p = 0.029), the use of antipsychotics (p = 0.022) and BMI (p = 0.001) were statistically significant for predicting Twiddler's syndrome.ConclusionTwiddler's syndrome is an uncommon complication of neuromodulation implantable devices. Younger age, use of antipsychotics, and high BMI are risk factors that can be used to facilitate rapid diagnosis and treatment.© 2016 International Neuromodulation Society.

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