Clinical and urodynamic effect of methylphenidate for the treatment of giggle incontinence (enuresis risoria)

Chang, Joo-Hyun; Lee, Kwang-Yeom; Kim, Tae-Beom; Yoon, Sang-Jin; Lee, Tack; Kim, Khae Hawn

doi:10.1002/nau.21046

Cited by 20 publications

(24 citation statements)

References 22 publications

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“…Despite the majority of past studies GI showed some subjective improvement in lower urinary tract function. Chang et al (8) reported that MPH is one of the primary treatment related to increasing urethral closure pressure while the relationship between GI and detrusor overactivity was not possible to be established in their study even including urodynamic parameters. Botulinum toxin A injection has also been used for the treatment of GI that might be related to detrusor overactivity (9).…”

Section: Discussionmentioning

confidence: 88%

609 Can the success of structured therapy for giggle incontinence be predicted?

Telli¹,

Hamidi²,

Kayis³

et al. 2015

European Urology Supplements

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ARTICLE InfO ______________________________________________________________ ______________________Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. Material and methods:The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment.Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.

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Section: Discussionmentioning

confidence: 88%

609 Can the success of structured therapy for giggle incontinence be predicted?

Telli¹,

Hamidi²,

Kayis³

et al. 2015

European Urology Supplements

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“…However, the findings of a few studies suggest a possible beneficial effect of methylphenidate in the therapy of patients with voiding dysfunctions such as giggle incontinence, which improved following medication administration [12,13]. The urodynamic changes induced by this drug, even in those studies, have never been elucidated.…”

Section: Discussionmentioning

confidence: 99%

“…Impairment of the dopaminergic tracts leading to inappropriate inhibition is the hallmark of ADHD [1,15]. The main mechanism of action by which methylphenidate suppresses the symptoms of ADHD is thought to involve modulation of the catecholamines in the prefrontal cortex of the brain through binding to the dopamine transporter [13]. The prefrontal cortex is believed to be involved in goal-directed behaviors and the processes of attention, which might be involved in the determination to start the voiding process by the autonomic nervous system [9,18].…”

Section: Discussionmentioning

confidence: 99%

Acute Dose-Related Differential Effects of Methylphenidate on Murine Cystometric Parameters

Choi

Cho

et al. 2013

Int Neurourol J

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PurposeMethylphenidate is the most widely used central nervous system stimulant in patients with attention deficit hyperactivity disorder. However, few studies have assessed its effects on voiding. Various doses of methylphenidate were investigated for their effects on cystometric parameters in conscious mice.MethodsTen male C57BL/6 mice, weighing between 20 and 23 g, were used in this study. To compare the acute drug responses before and after the oral medication was administered in the awake condition, we injected the solution through a catheter inserted into the stomach. Methylphenidate (1.25, 2.5, and 5 mg/kg) in an injection volume of 0.05 mL was administered.ResultsFour mice that received high doses of methylphenidate (2.5 and 5 mg/kg) showed no voiding contraction, with urine leakage. Six mice that received a low dose of methylphenidate (1.25 mg/kg) showed typical micturition cycles before and after administration. The micturition pressure decreased and bladder capacity increased without an increased residual volume after administration.ConclusionsMethylphenidate has differential, dose-dependent effects on the function of the lower urinary tract, due to the dependent relationship between the brain and lower urinary tract. Especially at higher doses, this drug may interfere with normal micturition. Therefore, more detailed clinical or experimental studies are warranted in the future.

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“…The authors concluded that laughter induced unstable detrusor contractions in children susceptible to detrusor instability. When bothersome, methylphenidate (Ritalin) has been shown to be useful as a therapeutic option [22].…”

Section: Giggle Incontinencementioning

confidence: 99%