TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS): A NEW APPROACH TO IMPROVE BLADDER FUNCTIONS IN CHILDREN WITH PRIMARY NOCTURNAL ENURESIS (PNE)

D.V. Shah¹, D.T. Palekar¹

¹Dr. D. Y. Patil Vidyapeeth, Physiotherapy, Pune, India

Background: Primary nocturnal enuresis (PNE) sometimes is an important developmental problem for school age children, which presents significant psychosocial problems for children and their parents. With this regard, nocturnal enuresis is evaluated as an important public health problem. the possible contributing factors in PNE are detrusor instability, reduction in functional bladder capacity, weak pelvic muscles, sleep disorders​ and stress. Transcranial Direct current stimulation (tDCS) has the effect on cortical electrical activity in brain. The prefrontal cortex controls the micturition along with pontine micturition centre which responsible for bladder functions. So the cranial stimulation of this area might improve the bladder functions and control.

Purpose: The aim was to study the effect of Transcranial direct current stimulation on bladder function in children with PNE.

Methods: Children with confirmed diagnosis of Primary Nocturnal Enuresis by paediatrician were selected as per the inclusion criteria. In this experimental study 45 children’s age from 5 to 15 years were recruited with parent’s concern. All children were selected from different schools, residential areas and Inpatient department of Dr. D. Y. Patil college of physiotherapy. Children were treated by tDCS and set of pelvic floor muscle exercises for 20 minutes. The protocol of the treatment was 5 days a week for the period of 4 weeks; which gives 20 sessions in 4 weeks. The Bladder functions were assessed by Bladder Diary, Dysfunctional voiding Score system (DVSS), and surface electromyography (sEMG) of PFMs.

Results: The data were analysed by MedcalcVersion 18.2.1software. Parametric tests were applied after confirming the normal distribution of data. There were 27 boys and 18 girls with mean age of (7.2 years). The mean value of peak to peak amplitude in sEMG of PFM before and after treatment was 174.9 ± 25.02 and 296±36-82 respectively. The pre and post DVSS Score was 10±2 and 5.90±1.2. Bladder diary shows reduction in frequency of bedwetting from mean of 4/week to 1/week. The pre and post values were compared by using t-test showed significant difference (P<0.05) at 95% confidence interval.

Conclusions: Clinically as well as significantly the study showed that 4 weeks of combined tDCS and PFM strengthening exercises had beneficial effect on the bladder functions specifically on Bedwetting frequency DVSS score and surface electromyography.

Implications: A new method of Neuro-modulation i.e. Transcranial direct current stimulation (tDCS) has been reported to be safe and potentially effective adjunct therapy to improve bladder functions in children with Enuresis. So, tDCS can be implemented for bedwetting rehabilitation.

Funding acknowledgements: self

Keywords:
Primary Nocturnal Enuresis
Transcranial Direct Current stimulation
Surface electromyograpy

Topics:
Paediatrics
Health promotion & wellbeing/healthy ageing/physical activity
Globalisation: health systems, policies & strategies

Did this work require ethics approval? Yes

Institution: Dr. D. Y. Patil Vidyapeeth

Committee: Dr. D. Y. Patil Vidyapeeth

Ethics number: DYPV/EC/454/2020