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Examination of the structured withdrawal program to prevent relapse of nocturnal enuresis
R J Butler1, P Holland, J Robinson
1Leeds Community and Mental Health (NHS) Trust and Leeds Acute Hospitals Trust, Leeds, United Kingdom.
Insights
A structured withdrawal program effectively reduces relapse in children with nocturnal enuresis after medication cessation. This approach offers a rapid alternative to gradual tapering, promoting sustained dryness.
Area of Science:
- Pediatric Nephrology
- Sleep Medicine
- Behavioral Pediatrics
Background:
- Nocturnal enuresis treatment relapse is common, especially after medication withdrawal.
- Pharmacological treatments like desmopressin and imipramine have high relapse rates.
- Gradual medication tapering is standard but often ineffective and time-consuming.
Purpose of the Study:
- To evaluate the effectiveness of a structured withdrawal program for nocturnal enuresis.
- To identify factors influencing successful medication cessation in children.
- To offer a rapid and effective alternative to gradual tapering for enuresis treatment.
Main Methods:
- An 8-week structured withdrawal program was implemented for 51 children (7-16 years old).
- Participants had a history of medication use (4-24 months) and prior withdrawal failures.
- Enuresis alarms were optional; progress was monitored, with success defined as no relapse at 6 months post-treatment.
Main Results:
- 74.5% of children remained dry during weeks 9-10 after complete medication cessation.
- Success rates were not significantly influenced by the use of an enuresis alarm.
- The program demonstrated a significant reduction in relapse rates.
Conclusions:
- The structured withdrawal program is an effective, rapid method for discontinuing medication in nocturnal enuresis.
- It offers a viable alternative to traditional gradual tapering strategies.
- Successful outcomes may be linked to the child's internal attribution of dryness rather than external factors like medication.
Purpose:
A variety of treatment options are available for children with nocturnal enuresis. The success of any intervention depends on if the child remains dry once the treatment is withdrawn. All interventions for children with nocturnal enuresis are vulnerable to some degree of relapse. Pharmacological interventions, involving either desmopressin or imipramine, seem particularly susceptible to relapse occurring rapidly once medication is withdrawn. The usual practice is to taper the dose gradually although this is time-consuming and of questionable effectiveness. An alternative approach is to use a time-limited structured withdrawal program, the success of which has been recently documented. We investigated the effectiveness of the structured withdrawal program to understand the variables related to success.
Materials And Methods:
A total of 51 patients 7 to 16 years old were included in the 8-week structured withdrawal program. Patients were 90% dry with medication taken for 4 to 24 months before the program and had experienced 2 unsuccessful withdrawal attempts. Patients were offered the choice of using an enuresis alarm on medication-free nights. Progress was monitored at 2, 5 and 8 weeks, and long-term success was defined as no relapse 6 months after cessation of treatment.
Results:
At weeks 9 and 10 with complete cessation of medication 74.5% of children remained dry, and success was not related to use of an enuresis alarm.
Conclusions:
The structured withdrawal program significantly reduces relapse rates, and offers an alternative and rapid means of successfully withdrawing medication. It is argued that the influential variable concerns the ability of the child to shift attribution for success from an external source (that is medication) to an internal focus (that is changes in themselves).