Abstract General Information

Title

NEURO-CORRELATES OF NOCTURNAL ENURESIS IN CHILDREN

Introduction and objective

Nocturnal enuresis (NE) leads to involuntary urination during nighttime and causing distress for both the child and their caregivers. Our study seeks to understand the brain structure-related factors linked to NE in children and compare the findings with a group of pediatric patients without additional health issues or socioeconomic factors.

Method

Using the clinical and imaging data from the ABCD database (https://abcdstudy.org/). We extract a group of 537 experiencing NE but did not have symptoms of constipation, daytime incontinence, or encopresis and a control group of 488 participants who had no history of urinary incontinence, mental health comorbidities, parental drug use, parental mental health issues, or constipation. We conducted a univariate logistic regression analysis, adjusting for age, sex, and race, to identify neuroimaging measures associated with nocturnal enuresis. These measures included fractional anisotropy, neurite density, mean -, radial -, and axial diffusivity of white matter tracts, as well as cortical region thickness and surface areas, and functional network connectivity correlations. FDR was applied for multi comparison correction. We then compared the results of 57 individuals with NE, who did not exhibit symptoms of constipation, daytime incontinence, encopresis, or mental health issues, as confirmed by parental interviews, with the control group using the same approach.

Results

The control group had an average age (SD) of 120.57 (7.45) months, with 25.61% females. The case group had an average age of 118.29 (7.22) months, with 52.66% females. The comorbidities-free group had an average age of 119.67 (6.67) months, with 28.07% females. Those with NE exhibited significantly thicker cortical regions in the brain (adjusted p<0.05). We also observed increased functional connectivity in brain networks among individuals with NE. When compared to the comorbidity-free group, the insula cortex, as the only region, showed significantly larger cortical volume area (adjusted p-value=0.0278) and surface area (adjusted p-value=0.0251).

Conclusion

Higher functional connectivity and cortical thickening in the networks and regions are associated with NE responsible for processing emotions and behavior regulation, executive function, tonic alertness, and auditory processing. By excluding individuals with comorbidities, we have identified a second type of NE in a reduced set of 10% of the patients with the insula as a key structure with no connectivity alteration. This might explain the reduced response rates to bladder sensation altering medications as compared to medications that increase frontal-attention-networks (NE central-agonists.