Deep brain stimulation (DBS) is the technique of neurostimulation of deep brain 
structures for the treatment of conditions such as essential tremor, dystonia, 
Parkinson's disease and chronic pain syndromes. The procedure uses implanted 
deep brain stimulation electrodes connected to extension leads and an 
implantable pulse generator (IPG). Hardware failure related to the DBS procedure 
is not infrequent, and includes electrode migration and disconnection. We 
describe a patient who received bilateral globus pallidus internus DBS for 
dystonia with initially good clinical response, but the device eventually 
failed. Radiographs showed multiple twisting of the extension leads with 
disconnection from the brain electrodes and a diagnosis of Twiddler's syndrome 
was made. Twiddler's syndrome was first described in patients with cardiac 
pacemakers. Patients with mental disability, elderly and obese patients are at 
increased risk. Twiddler's syndrome should be suspected whenever there is a 
failure of the DBS device to relieve symptoms previously responsive to 
stimulation. Surgical correction is usually required.