Department of Pediatrics, University Clinics of Schleswig-Holstein, Kiel, Germany.
Acta Paediatr. 2012 Jul;101(7):e304-8. doi: 10.1111/j.1651-2227.2012.02624.x. Epub 2012 Feb 23.
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.
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.
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%.
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.
单症状性遗尿症（ME）是儿童常见的疾病，会产生严重的社会和心理后果。治疗通常以去氨加压素（dDAVP）和/或报警器治疗作为一线治疗，以丙咪嗪作为二线治疗开始。所有治疗方法均已被证明有效，但并非对所有患者都有效。因此，根据治疗效果对患者进行分组将是有益的。
一组对一线治疗有抗药性的患者接受丙咪嗪治疗，并与成功接受 dDAVP 和/或报警器治疗的匹配对照组进行比较。所有患者均测量了听觉惊跳反射的预脉冲抑制（PPI）。
在 23 名无反应者中，中位数 PPI 为 72%（范围 43-94%），而匹配的 dDAVP/报警器-反应者中位数 PPI 为 26%（范围 0-61%）（p <0.0001）。丙咪嗪的反应率为 87%。
所提供的数据表明，PPI 可识别 ME 的两个亚组。结果进一步深入了解 ME 中涉及的（至少）两种不同的发病机制：（i）反射抑制的成熟延迟，导致 PPI 降低，以及（ii）PPI 正常，可能存在异常的睡眠模式，丙咪嗪可对其产生影响。
