Dhondt, Karlien

Raes, Ann

Van Herzeele, Charlotte

Vande Walle, Johan

English

Ghent University Academic Bibliography

© 2010 Universitair Ziekenhuis GentNEU ROLOGIENEF ROLOGIECOMORBIDITY BETWEEN ENURESIS NOCTURNA, HYPERACTIVITY AND SLEEPDISORDERSJ.Vande Walle, K.Dhondt, C. Van Herzeele, A.Raes,NE   ROLOGIE2© 2010 Universitair Ziekenhuis GentNocturnal enuresis3© 2010 Universitair Ziekenhuis GentIntroductionBefore 1989Nocturnal enuresisWas a benign conditionNot harming anybodySelflimiting.. since it disappeared spontaneouslyNot necessary to treat, except in rare casesAnd if there was a cause..it was generally accepted that  it had to be a psychological cause4© 2010 Universitair Ziekenhuis GentIntroduction1989-2009enuresis is an organic conditionCaused by hereditary factorsSubdivided into  Non monosymptomatic / monosymptomatic enuresis Where MNE is characterised byA mismatch between nocturnal diuresis  volume and  functional bladder volumeOnly spontaneously disappearing  in mild cases, without comorbidity factorsWith psychological consequences for child and and familydiscussion desmopressin versus alarm as treatment of choice5© 2010 Universitair Ziekenhuis GentNocturnalPolyuriaReduced NocturnalBladder CapacityNocturnal EnuresisImpaired Arousal Responseto Bladder FullnessPathophysiology of Nocturnal Enuresis( A heterogeneous disorder )6© 2010 Universitair Ziekenhuis GentPercentile 2011Back to historyForget the whole article7© 2010 Universitair Ziekenhuis GentIntroduction2009 - 2019enuresis is an organic diseaseA mismatch between diuresis volume and  functional bladder volume overnight / hereditary (genes)“Only” spontaneously disappearing  in mild casesImportance of comorbidity factorsWith severe psychological consequencesFor child (selfesteem, burden), and and family (intolerance)With  significant influence on cognitive functions of the childmaking a wait and see attitude is not longer defendable8© 2010 Universitair Ziekenhuis Gent© 2010 Universitair Ziekenhuis GentCognitive disturbances following night-time wetting in children1. The CK Yeung theory2. Is there evidence ?10© 2010 Universitair Ziekenhuis GentCK Yeung ICCS Hong Kong 2006                   Correlation between1. Enuresis2. Bladderdysfunction3. Attention deficit4. Sleep disturbances11© 2010 Universitair Ziekenhuis GentAre Enuretics Really Deep Sleepers ??12© 2010 Universitair Ziekenhuis GentBrain dysfunctionBladder disorders?Does a Bladder-and-Brain Dialogue exist??13© 2010 Universitair Ziekenhuis GentBrain dysfunctionBladder disorders?Does a Bladder-and-Brain Dialogue exist??14© 2010 Universitair Ziekenhuis GentCK Yeung ICCS Hong Kong 2006                   1. Bladder function tests2. Sleep Architecture and Cortical Arousal3. Brainstem FunctionPrepulse Inhibition of Startle (PPI) ReflexLatency P300 event-related brain potential (ERP)4. Cognitive Performance-testsintelligence score (Raven Progressive Matrices Test) focused attention (Digit Cancellation Test) short-term memory (HK List Learning Test)retention ability & long-term memory (HK List Learning Test) shifted attention, learning speed and reaction (Conner’s Continuous Performance Test) In patients with enuresis worse than in controlsBut normalises after therapyBut …. data remain unpublished© 2010 Universitair Ziekenhuis GentNormal ChildrenBladder Behaviour and Sleep Changes© 2010 Universitair Ziekenhuis GentEnuretic ChildrenBladder Behaviour and Sleep Changes17© 2010 Universitair Ziekenhuis Gent18© 2010 Universitair Ziekenhuis Gent19© 2010 Universitair Ziekenhuis GentTheory from CK YeungNocturnal enuresisCauses sleep disturbanceOverstimulation of central brainCognitive dysfunctionTreatment of nocturnal enuresisAmelioration of sleepLess exhaustion of the brainAmelioration of cognitive function20© 2010 Universitair Ziekenhuis GentAnimal model21© 2010 Universitair Ziekenhuis GentAnimal modelcerebral dysfunction22© 2010 Universitair Ziekenhuis GentTheory from CK YeungNocturnal enuresisCauses sleep disturbanceOverstimulation of central brainCognitive dysfunctionTreatment of nocturnal enuresisAmelioration of sleepLess exhaustion of the brainAmelioration of cognitive function23© 2010 Universitair Ziekenhuis GentCK Yeung ICCS Hong Kong 2006                   1. Bladder function tests2. Sleep Architecture and Cortical Arousal3. Brainstem FunctionPrepulse Inhibition of Startle (PPI) ReflexLatency P300 event-related brain potential (ERP)4. Cognitive Performance-testsintelligence score (Raven Progressive Matrices Test) focused attention (Digit Cancellation Test) short-term memory (HK List Learning Test)retention ability & long-term memory (HK List Learning Test) shifted attention, learning speed and reaction (Conner’s Continuous Performance Test) In patients with enuresis worse than in controlsBut normalises after therapyBut …. data remain unpublished© 2010 Universitair Ziekenhuis GentCognitive disturbances following night-time wetting in children1. The CK Yeung theory2. Is there evidence ? NO = NO publication25© 2010 Universitair Ziekenhuis Gent• -.Is there evidence ?Comorbidity = yes / causality = No/ = circulus viciosus26© 2010 Universitair Ziekenhuis GentADHDCircadian rythm27© 2010 Universitair Ziekenhuis GentCircadian rythmADHD28© 2010 Universitair Ziekenhuis GentD. BAEYENSCircadian rythmADHDS. RITTIGS. RITTIG29© 2010 Universitair Ziekenhuis GentThe egg/ chickensleepenuresisADHDCognitive dysfunctionTherapy resistanceDiuresis/Bladder30© 2010 Universitair Ziekenhuis GentRRSleep  disorderdrugsbladderNoctpolyuriasolutesADDADHDSodiumNocturia31© 2010 Universitair Ziekenhuis GentOAB coincides with sleepdeprivation / ADHD symptoms (CK Yeung )1999 Scan J U N Supplsleep disturbances and bladder dysfunction: common in treatment-resistant enuresis2008 N Engl Med (letter)interaction between bladder overactivity and brain arousabilityNE more lighter sleep associated with(1) frequent cortical arousals(2) inability to awaken completelyTransition from light sleep to complete awakening may be suppressed by long-term overstimulation by signals from the bladder32© 2010 Universitair Ziekenhuis GentOAB coincides with sleepdeprivation / ADHD symptoms (CK Yeung )2009 Ped Urol Suppl (6 months treatment)sleep awakening threshold ↓number of awakenings ↑P300 ERPs latency ↓PPI of startle amplitude ↓ brain function normalized in parallel to ↓ bladder dysfunction• 2010  J Urol (Xiang et al)functional brainstem changes in response to bladder function alterationelicited by surgical reduction in bladder capacity 33© 2010 Universitair Ziekenhuis GentSleepdeprivation results inNocturnal polyuria NatriuresisKaliuresisReduced dipping bloodpressure overnightHigher renin aldosteron-levelsRittig, 2009 PhD Mahler, Kamperis 2010 Am J Phys Ren Phys34© 2010 Universitair Ziekenhuis GentNocturnal polyuria is associated with abnormal superficial sleep and restless legs syndrome(K Dhont Ghent, J Urology)Disrupted sleep architecture in children:high incidence of PLMSincreased cortical arousability leading to awakeningIncreased PLMS during sleep  frequently followed by cortical arousal35© 2010 Universitair Ziekenhuis GentNocturnal polyuria is associated with abnormal superficial sleep and restless legs syndrome (K Dhont Ghent)36© 2010 Universitair Ziekenhuis GentAssociation between nocturnal polyuria and OAB J.Urology 2007 Vande Walle37© 2010 Universitair Ziekenhuis GentD. Baeyens (Ghent): Association of enuresisAnd ADHD = cognitive dysfunction2004 J Urol15% of enuretic children: ADHD-COM22.5%: ADHD-IAprevalence of ADHD higher in older children (9-12 vs 6-8y)mainly Nocturnal polyuria2005 Acta Ped2y follow up prevalence73% of ADHD diagnoses can be reconfirmed38© 2010 Universitair Ziekenhuis GentD. Baeyens (Ghent): Association of enuresisAnd ADHD = cognitive dysfunction2006 Acta PedPrevalence rate of ADHD is increased in an enuretic population compared to community samplesMainly nocturnal polyuria2007 J Urol4y follow up prevalence64% of ADHD diagnoses can be reconfirmed39© 2010 Universitair Ziekenhuis GentD. Baeyens (Ghent): Association of enuresisAnd Prepulse inhibition2006 J Urolbrainstem inhibition deficit in children with enuresis (PPI)ADHD-IA: when additional attention is allocated to specific trials in the task, they fail to optimize sensory gating.  Enuresis + ADHD-IA: identification problem of bladder signals  inadequate/absent arousal effect • 2007 J Urol 2y follow up brainstem inhibition no sign difference between enuresis and control group brainstem maturation not associated with children becoming dry40© 2010 Universitair Ziekenhuis GentD. Baeyens (Ghent): Association of enuresisAnd Prepulse inhibitionPPI = prepulse inhibitionMeasurement of attentional information processingHow? SEM (Startle Eyeblink Modification)PPI startle reflex41© 2010 Universitair Ziekenhuis GentD. Baeyens (Ghent): Amelioration of ADHD coincides with amelioration of enuresis (J Urology)42© 2010 Universitair Ziekenhuis GentIs this the rediscovery of the wheel?If you had a bad night yesterday…Were you easy awake this morning ?Were you not dizzy?, sleepy?, less concentrated?Do you not want to have a nap this afternoon?If you have a full bladder and my talk is to longAre you listening to me?Are you concentrated?Or are you looking to your watch? 43© 2010 Universitair Ziekenhuis GentconclusionEnuresis nocturna is not a selflimiting “benign” disorderThe potential psychological side-effects, but certainly the negative influence on cognitive functionsMakes the wait and see attitude not longer defendableDemands more effective treatment strategies, based on EBM, but targetting earlier in lifeComorbidity between enuresis / therapy-resistance / cognitive functions / sleepdisorders 

Co-morbidity between enuresis nocturna, hyperactivity and sleep disorders

https://biblio.ugent.be/publication/8647713/file/8647717.pdf

Co-morbidity between enuresis nocturna, hyperactivity and sleep disorders

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