title: Differentiation of subgroups of monosymptomatic enuresis according to prepulse inhibition of the startle reflex.
abstract: OBJECTIVE
  Monosymptomatic enuresis (ME) is a common disorder in children with serious social and psychological consequences. Treatment is usually initiated with desamino-arginine vasopressin (dDAVP) and/or alarm therapy as first-line treatment and imipramine as second-line. All treatments have proven efficacy, but are not successful with all patients. Therefore, a differentiation into subgroups according to treatment efficacy would be beneficial.
  
  
  METHODS
  A group of patients resistant to first-line treatment was treated with imipramine and compared with matched controls successfully treated with dDAVP and/or alarm therapy. Prepulse inhibition (PPI) to acoustic startle reflexes was measured in all patients.
  
  
  RESULTS
  In a group of 23 nonresponders, the median PPI was 72% (range 43-94%) compared with the matched dDAVP/alarm - responders with a median PPI of 26% (range 0-61%) (p < 0.0001). The response rate to imipramine was 87%.
  
  
  CONCLUSIONS
  The presented data provide evidence that PPI allows to identify two subgroups of ME. The results offer further insight into (at least) two different pathomechanisms involved in ME: (i) a maturational delay of reflex inhibition with reduced PPI and (ii) a normal PPI, possibly with abnormal sleep patterns, that can be influenced by imipramine.
authors.affiliation: Department of Pediatrics, University Clinics of Schleswig-Holstein, Kiel, Germany. p.eggert@pediatrics.uni-kiel.de
authors.forename: Paul
authors.initials: P
authors.lastname: Eggert
authors.forename: Sönke
authors.initials: S
authors.lastname: Freischmidt
authors.forename: Phillip V
authors.initials: PV
authors.lastname: Bismarck
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schulz-Jürgensen
mesh_terms: D000161:Acoustic Stimulation; D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D050034:Antidiuretic Agents / Q000627:therapeutic use; D002648:Child; D056902:Clinical Alarms; D003131:Combined Modality Therapy; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D008297:Male; D053206:Nocturnal Enuresis / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D011446:Prospective Studies; D011931:Reactive Inhibition; D013216:Reflex, Startle; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin; D007099:Imipramine