Neurophysiological aspects of enuresis in children

Introduction. Enuresis is a pathological condition, manifested by involuntary urination during sleep or in the wakeful state. It is believed that enuresis is associated with unformed or impaired self-control skills for emptying the bladder. The significance of the problem is determined by the widespread prevalence of pathology, social and psychological maladaptation of children with enuresis. An important role in this plays the development of their personality by an accentuated type often, difficult adaptability, and lack of ability to integrate into the team, especially into the semi or closed type. According to modern concepts, enuresis can be caused by the following reasons: delayed maturation of the nervous system, urological pathology and urinary tract infection, impaired activation reaction during sleep, impaired rhythm of secretion of antidiuretic hormone, adverse heredity, psychological factors and stress. The results of Russian and foreign scientists studies revealed the polyetiological character of enuresis and the impossibility, in most cases, of identifying its obvious cause. This explains the relatively wide variability of outcomes: from spontaneous cure to apparent resistance to all existing treatments. The significant prevalence of enuresis, the relative severity of this pathology and the lack of effective treatment methods necessitate the search for alternative methods of therapy or fundamentally new approaches to using existing ones, which is impossible without a thorough study of this disease etiopathogenesis.

The goal of research — is to study the neurophysiological characteristics of enuresis in children.

Materials and methods. Prospective controlled study was conducted in Kazan State Medical Academy — a branch of the RMACPE (Kazan) in the period 2003–2019 years. To study enuresis mechanisms we carried out a comprehensive clinical-electroneurophysiological examination of 93 children aged 5 to 15 years, suffering from bedwetting. The control group consisted of 40 healthy children who were comparable in age and gender to those in the main group. All patients underwent a comprehensive examination, which included the study of complaints, anamnesis, clinical and electroneurophysiological research.

Results. Clinical examination of children with enuresis revealed signs of minimal cerebral dysfunction. An electrophysiological examination made it possible to determine an increase in the refl ex excitability of brain stem structures against the background of a decrease in downward inhibitory control.

Conclusion. The predominance of excitation processes over inhibition in the central nervous system is mainly observed in children with enuresis. The weakness of the inhibitory mechanisms due to constitutional factors, pathology of the nervous system that took place earlier, allows making an assumption about the diffuse nature of the disorders of the nervous system in this urination disorder. 

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