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Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep.

Van Herzeele C, Dhondt K, Roels SP, Raes A, Hoebeke P, Groen LA, Vande Walle J.

Pediatr Nephrol. 2016 Apr 11

Editor's comment:
The sleep of children suffering from nocturnal enuresis has been in researchers’ focus for decades. Different aspects have been evaluated such as sleep architecture and quality, arousal as well as renal functions during sleep. Recent studies have drawn attention to sleep and the neuropsychological functioning of children that experience wet nights.

This study attempts to answer the question: do children improve their sleep quality and neuropsychological functioning when treated successfully for bedwetting?

For this purpose the authors recruited 35 children between 6 and 16 years of age with monosymptomatic nocturnal enuresis and nocturnal polyuria, the typical candidates for treatment with desmopressin. All children underwent polysomnographic studies as well as neuropsychological testing before and 6 months after starting treatment. The following areas of neurocognitive functioning were assessed: quality of life, attention, executive function, internalizing and externalizing problems.

The authors found a significant number of children with enuresis with pathologic periodic limb movement index. A reduction in the average PLM index was evident 6 months following initiation of treatment. Although not well understood in terms of pathophysiology, periodic limb movements – the short uncontrollable muscle movements during sleep – have been related to conditions such as depression, ADHD, narcolepsy and other neurological disorders. It is speculated that there is a common neurological pathway with enuresis.

Regarding neuropsychological functioning the authors found improvements in areas such as quality of life as perceived by the parents, executive function and internalizing problems.

This is the first study to show improvement of sleep and neuropsychological functioning in children with the monosymptomatic form of nocturnal enuresis without evidence of bladder dysfunction. On the basis of these observations the authors hypothesize that there is a common neurodevelopmental pathway for both conditions. Further studies are needed in order to prove this. However, it has already become clear that nocturnal enuresis seems to be related with poor sleep and neuropsychological dysfunction and successful treatment may improve the daytime functioning of these children.

These observations stress the importance of prompt and successful treatment of the condition.

Abstract

 

Background:

There is a high comorbidity between nocturnal enuresis, sleep disorders and psychological problems. The aim of this study was to investigate whether a decrease in nocturnal diuresis volume not only improves enuresis but also ameliorates disrupted sleep and (neuro)psychological dysfunction, the major comorbidities of this disorder.

Methods:

In this open-label, prospective phase IV study, 30 children with monosymptomatic nocturnal enuresis (MNE) underwent standardized video-polysomnographic testing and multi-informant (neuro)psychological testing at baseline and 6 months after the start of desmopressin treatment in the University Hospital Ghent, Belgium. Primary endpoints were the effect on sleep and (neuro)psychological functioning. The secondary endpoint was the change in the first undisturbed sleep period or the time to the first void.

Results:

Thirty children aged between 6 and 16 (mean 10.43, standard deviation 3.08) years completed the study. The results demonstrated a significant decrease in periodic limb movements during sleep (PLMS) and a prolonged first undisturbed sleep period. Additionally, (neuro)psychological functioning was improved on several domains.

Conclusions:

The study demonstrates that the degree of comorbidity symptoms is at least aggravated by enuresis (and/or high nocturnal diuresis rate) since sleep and (neuro)psychological functioning were significantly ameliorated by treatment of enuresis. These results indicate that enuresis is not such a benign condition as has previously been assumed.


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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition.