Transcranial magnetic stimulation identifies cortical excitability changes in monosymptomatic nocturnal enuresis.
OBJECTIVE
A limited number of electroencephalography (EEG) studies in nocturnal enuresis (NE) have reported cortical dysmaturity. The aim of the present study was to test this notion by examining cortical excitability in subjects with nocturnal enuresis (NE) using transcranial magnetic stimulation (TMS).


METHODS
We investigated 41 patients with NE meeting the DSM-IV diagnostic criteria for NE, and 18 age- and sex-matched controls. Each subject was assessed clinically regarding frequency, duration of enuresis and Health Survey Measurement. Neurophysiological measures included resting and active motor thresholds (RMT, AMT), motor evoked potentials (MEP) of upper and lower limbs, cortical silent period duration (CSP) and transcallosal inhibition (TCI), in the upper limbs.


RESULTS
Patients had a significantly lower Health Survey Measurement score for both physical and mental health components compared to the control group. RMT and AMT of both upper and lower limbs as well as the duration of the CSP and TCI were significantly reduced compared with the control group. There was significant positive correlation between RMT, AMT and Health Survey Measurement scores, especially Social Functioning.


CONCLUSIONS
Patients with nocturnal enuresis are characterized by pathologically increased excitability and reduced inhibitory processing in the motor cortex, which could contribute to the pathogenesis of nocturnal enuresis.
Department of neuropsychiatry, Assiut university hospital, Assiut, Egypt. Electronic address: emankhedr99@yahoo.com.
E M
EM
Khedr
Department of neuropsychiatry, Assiut university hospital, Assiut, Egypt.
N
N
Abo-Elfetoh
Department of neuropsychiatry, Assiut university hospital, Assiut, Egypt.
K A
KA
Elbeh
Department of neuropsychiatry, Assiut university hospital, Assiut, Egypt.
A A
AA
Baky
Rheumatology and rehabilitation department, faculty of medicine, Assiut University, Assiut, Egypt.
R M
RM
Gamal
Rheumatology and rehabilitation department, faculty of medicine, Assiut University, Assiut, Egypt.
D
D
El Hammady
Department of neuropsychiatry, Assiut university hospital, Assiut, Egypt.
F
F
Korashy
D000293:Adolescent; D000328:Adult; D002648:Child; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D009433:Neural Inhibition; D053206:Nocturnal Enuresis / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult
Cortical excitability; Cortical silent period; Excitabilité corticale; Inhibition transcalleuse; Nocturnal enuresis; Période de silence corticale; Resting and active motor threshold; Seuil moteur au repos et sous activation; Transcallosal inhibition; Énurésie nocturne