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Prepulse inhibition of the startle reflex for differentiation of enuresis in children
1Hospital for Children and Adolescents, University Leipzig, Leipzig, Germany.
Insights
Children with non-monosymptomatic enuresis (nmE) show impaired central reflex control compared to those with monosymptomatic enuresis (mE). This suggests central nervous system dysfunction may be key in nmE etiology.
Area of Science:
- Neuroscience
- Pediatrics
- Urology
Background:
- Enuresis in children is classified as monosymptomatic (mE) or non-monosymptomatic (nmE), with nmE including daytime symptoms.
- Growing evidence suggests a central origin for enuresis, potentially linked to impaired brainstem reflex control, but findings are inconsistent.
- Previous studies have not differentiated central reflex control between mE and nmE pediatric populations.
Purpose of the Study:
- To investigate differences in central reflex control between children with mE and nmE.
- To determine if prepulse inhibition (PPI) of the startle reflex varies between these enuresis subtypes.
Main Methods:
- Thirty children (ages 5-14) with enuresis were divided into mE and nmE groups based on clinical history and bladder diaries.
- Prepulse inhibition (PPI) of the startle reflex was measured in both groups.
- PPI levels were statistically compared between the mE and nmE groups.
Main Results:
- A significant difference in PPI was found between the groups (p=0.0002).
- The nmE group exhibited a significantly lower median PPI level (10%) compared to the mE group (73%).
Conclusions:
- Impaired central control, as indicated by reduced PPI, appears to be specifically associated with the etiology of non-monosymptomatic enuresis.
- These findings may necessitate a re-evaluation of enuresis classification and highlight potential neurological underpinnings in nmE.
Abstract:
Children with enuresis can be classified into those who wet their beds only at night (monosymptomatic enuresis, mE), and those who additionally suffer from daytime symptoms, such as urgency or incontinence (non-monosymptomatic enuresis, nmE). Evidence is growing that enuresis may have a central origin: bedwetting children have lower brainstem reflex control (impaired prepulse inhibition) than normal controls. However, findings on this subject are inconsistent. To date, there has been no study in pediatric patients according to the type of enuresis. With the aim of determining whether mE and nmE children differ in terms of central reflex control, we divided 30 enuretic children into two groups (mE and nmE) based on data recorded in a bladder diary and clinical history (19 with history of diurnal urge, 11 without; age 5-14 years). Prepulse inhibition (PPI) of the startle reflex of the children was measured and compared between groups. A significant difference in PPI was observed between the groups, with the nmE group having a lower median PPI level than the mE group (10 vs. 73%, respectively; p = 0.0002). These findings lead to the assumption that a loss of central control plays a role only in the etiology of nmE. Moreover, they may throw a new light on the classification of enuresis.
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