Neuromotor Development in Nocturnal Enuresis

von Gontard A, et al. Neuromotor Development in Nocturnal Enuresis. Developmental Medicine & Child Neurology September 2006; 48(9):744-750.

ABSTRACT: In children with nocturnal enuresis, a higher rate of minor neurological dysfunction has been found. The aim of this study was to assess timed performance (a measure of motor performance speed) and associated movements using a standardized and reliable instrument. The motor function of 37 children with nocturnal enuresis (27 males, 10 females; mean age 10y 7mo [SD 1y 6mo]; age range 8y–14y 8mo) and 40 comparison children without enuresis (17 males; 23 females; mean age 10y 7mo [SD 1y 6mo]; age range 87–14y 8mo) was assessed using the Zurich Neuromotor Assessment. Children with nocturnal enuresis showed a slower motor performance than comparison children, particularly for repetitive hand and finger movements. This study provides evidence for a maturational deficit in motor performance in children with nocturnal enuresis. In addition to a maturational deficit of the brainstem, it is proposed that there is a possible maturational deficit of the motor cortex circuitry and related cortical areas in children with nocturnal enuresis.

COMMENTS: It has been noted that children with nocturnal enuresis have a higher degree of minor neurological deficits compared to without nocturnal enuresis (10% vs 1%). Some opine that there is a disorder of brain maturation. A study of those with either nocturnal enuresis or day wetting had a greater prevalence of neurological soft signs, worse in the day wetting group. There was more dysdiadochokinesis and choreiform movements and diminished ability to imitate gestures in both groups compared to controls. This study used the Zurich Neuromotor Assessment which was developed in order separate ‘pure’ motor function from those that involve sensory functions. This test has two parts. One part measures timed performances by testing the movement speed of pure motor and adaptive tasks. The other assesses the quality of movements during these tasks. It was found that those both day and night wetting had more difficulty than those with night wetting only in static balance (adaptive movement) and alternating leg and hand movements. Those with secondary nocturnal enuresis had more difficulty with repetitive hand and finger movements than those with primary nocturnal enuresis. They opine that there might be maturational deficits in not only the brainstem as others have discussed, but with the motor cortex and associated cortical areas as well. Many children with nocturnal enuresis respond well to chiropractic care. A question that I have: would children who cease to have nocturnal enuresis after receiving chiropractic adjustments have improvements in brain function? That would be an interesting question to research. The children with nocturnal enuresis in this study had slower motor function. Would these children have improved motor function after adjustments. A interesting question that I hope a chiropractic research project (one that uses a specific contact, short-lever adjustment like the Gonstead technique) would attempt to answer.