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Neuropsychological functioning related to specific characteristics of nocturnal enuresis.
J Pediatr Urol. 2015 Aug; 11(4):208.e1-6.JP

Abstract

INTRODUCTION/BACKGROUND

There is a high comorbidity demonstrated in the literature between nocturnal enuresis and several neuropsychological dysfunctions, with special emphasis on attention deficit hyperactivity disorder (ADHD). However, the majority of the psychological studies did not include full non-invasive screening and failed to differentiate between monosymptomatic nocturnal enuresis (MNE) and non-MNE patients.

OBJECTIVE

The present study primarily aimed to investigate the association between nocturnal enuresis and (neuro)psychological functioning in a selective homogeneous patient group, namely: children with MNE and associated nocturnal polyuria (NP). Secondly, the study investigated the association between specific characteristics of nocturnal enuresis (maximum voided volume, number of wet nights and number of nights with NP) and ADHD-inattentive symptoms, executive functioning and quality of life.

STUDY DESIGN

The psychological measurements were multi-informant (parents, children and teachers) and multi-method (questionnaires, clinical interviews and neuropsychological testing).

RESULTS

Thirty children aged 6-16 years (mean 10.43 years, SD 3.08) were included. Of them, 80% had at least one psychological, motor or neurological difficulty. The comorbid diagnosis of ADHD, especially the predominantly inattentive presentation, was most common. According to the teachers, a low maximum voided volume (corrected for age) was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. No significant correlations were found between specific characteristics of enuresis and quality of life. Details are demonstrated in Table.

DISCUSSION

The children were recruited from a tertiary referral centre, which resulted in selection bias. Moreover, NP was defined as a urine output exceeding 100% of the expected bladder capacity for age (EBC), and not according to the expert-opinion-based International Children's Continence Society norm of 130% of EBC. The definition for NP of a urine output exceeding 100% of the EBC is more in line with the recent findings of the Aarhus group.

CONCLUSIONS

For children with MNE and associated NP, a high comorbidity with the predominantly inattentive presentation of ADHD was demonstrated. Children experienced problems with daytime functioning in relation to their wetting problem at night. According to the teachers, a low maximum voided volume was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. Although comorbidity is still the appropriate word to use, the observation favours a more complex pathogenesis of enuresis with a common pathway in the central nervous system, including: neurotransmitters, influencing neuropsychological functioning as well as sleep, circadian rhythm of diuresis and bladder function control.

Authors+Show Affiliations

Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium. Electronic address: charlotte.vanherzeele@ugent.be.Child Neurology & Metabolism, Pediatric Sleep Center, University Hospital Ghent, Ghent, Belgium.Department of Data-Analysis, University Ghent, Ghent, Belgium.Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium.Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium.Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium.Department of Pediatric Nephrology/Urology, University Hospital Ghent, Ghent, Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26206411

Citation

Van Herzeele, C, et al. "Neuropsychological Functioning Related to Specific Characteristics of Nocturnal Enuresis." Journal of Pediatric Urology, vol. 11, no. 4, 2015, pp. 208.e1-6.
Van Herzeele C, Dhondt K, Roels SP, et al. Neuropsychological functioning related to specific characteristics of nocturnal enuresis. J Pediatr Urol. 2015;11(4):208.e1-6.
Van Herzeele, C., Dhondt, K., Roels, S. P., Raes, A., Groen, L. A., Hoebeke, P., & Walle, J. V. (2015). Neuropsychological functioning related to specific characteristics of nocturnal enuresis. Journal of Pediatric Urology, 11(4), e1-6. https://doi.org/10.1016/j.jpurol.2015.04.033
Van Herzeele C, et al. Neuropsychological Functioning Related to Specific Characteristics of Nocturnal Enuresis. J Pediatr Urol. 2015;11(4):208.e1-6. PubMed PMID: 26206411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neuropsychological functioning related to specific characteristics of nocturnal enuresis. AU - Van Herzeele,C, AU - Dhondt,K, AU - Roels,S P, AU - Raes,A, AU - Groen,L-A, AU - Hoebeke,P, AU - Walle,J Vande, Y1 - 2015/06/27/ PY - 2014/12/18/received PY - 2015/04/03/accepted PY - 2015/7/25/entrez PY - 2015/7/25/pubmed PY - 2016/5/18/medline KW - Child KW - Child psychology KW - Enuresis KW - Polyuria SP - 208.e1 EP - 6 JF - Journal of pediatric urology JO - J Pediatr Urol VL - 11 IS - 4 N2 - INTRODUCTION/BACKGROUND: There is a high comorbidity demonstrated in the literature between nocturnal enuresis and several neuropsychological dysfunctions, with special emphasis on attention deficit hyperactivity disorder (ADHD). However, the majority of the psychological studies did not include full non-invasive screening and failed to differentiate between monosymptomatic nocturnal enuresis (MNE) and non-MNE patients. OBJECTIVE: The present study primarily aimed to investigate the association between nocturnal enuresis and (neuro)psychological functioning in a selective homogeneous patient group, namely: children with MNE and associated nocturnal polyuria (NP). Secondly, the study investigated the association between specific characteristics of nocturnal enuresis (maximum voided volume, number of wet nights and number of nights with NP) and ADHD-inattentive symptoms, executive functioning and quality of life. STUDY DESIGN: The psychological measurements were multi-informant (parents, children and teachers) and multi-method (questionnaires, clinical interviews and neuropsychological testing). RESULTS: Thirty children aged 6-16 years (mean 10.43 years, SD 3.08) were included. Of them, 80% had at least one psychological, motor or neurological difficulty. The comorbid diagnosis of ADHD, especially the predominantly inattentive presentation, was most common. According to the teachers, a low maximum voided volume (corrected for age) was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. No significant correlations were found between specific characteristics of enuresis and quality of life. Details are demonstrated in Table. DISCUSSION: The children were recruited from a tertiary referral centre, which resulted in selection bias. Moreover, NP was defined as a urine output exceeding 100% of the expected bladder capacity for age (EBC), and not according to the expert-opinion-based International Children's Continence Society norm of 130% of EBC. The definition for NP of a urine output exceeding 100% of the EBC is more in line with the recent findings of the Aarhus group. CONCLUSIONS: For children with MNE and associated NP, a high comorbidity with the predominantly inattentive presentation of ADHD was demonstrated. Children experienced problems with daytime functioning in relation to their wetting problem at night. According to the teachers, a low maximum voided volume was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. Although comorbidity is still the appropriate word to use, the observation favours a more complex pathogenesis of enuresis with a common pathway in the central nervous system, including: neurotransmitters, influencing neuropsychological functioning as well as sleep, circadian rhythm of diuresis and bladder function control. SN - 1873-4898 UR - https://www.unboundmedicine.com/medline/citation/26206411/Neuropsychological_functioning_related_to_specific_characteristics_of_nocturnal_enuresis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-5131(15)00222-3 DB - PRIME DP - Unbound Medicine ER -