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Somatic and auricular thermostimulation in adolescents with nocturnal enuresis
Carlo Di Stanislao, Vincenzo D’Onofrio, Dennis Konopacki.
“one of the main duties of the physician is to educate his patients to not take medications”
W.Osler
“ ancient medicine, not being able to cure the sick, was content to reanimate the dead”
J.Charles
Summary: Enuresis has a genetic predisposition. It is believed that there are four chromosomes involved in the development of the disorder: chromosome 13 in the region 13q13-13q14.2, chromosome 12 in the region 12q13, chromosome 8q and chromosome 22 in the region 22q11. these data, taken in light of the Classical Chinese Energy, makes one think of the Yuan points of the principle meridians in relation to the automatic cerebral part: Lung, Large Intestine, Stomach and Spleen Meridians. Points which are pertinent include; GV16, BL9 and GB19. We had treated, from Jan. 2002 to March 2003, three adolescents (2 males and a female), having an age between 12 to 14 yrs. of age, each of which had a minimum of three and a maximum seven episodes of bedwetting a week. All had a diagnosis of primary enuresis without urogenital disfunctions nor spina bifida. There were carried out two treatment sessions of somatic – auricular therapy each week, for a total of 10 weeks. Subsequently, follow up was done once a month for 6 months. The results obtained are discussed.
Key Words: enuresis, familial predisposition, chromosomes, skin and auricular thermostimulation
Enuresis is defined as involuntary urination in children having an age greater than 6-7 yrs. There are multiple definitions that have been given to date, some having differences which are not merely formal but substantial as well. Currently, in accordance with the definition given by the Incontinence Children Society, Enuresis is “the abnormal urination at an inopportune moment or at an unacceptable or inappropriate place” at an age in which voluntary control of urination should be present (at age 5 for females and age 6 for males).
Enuresis is divided into:
· Diurnal
· Nocturnal
Nocturnal enuresis is defined as the involuntary passage of urine during sleep; Diurnal enuresis refers to the involuntary or intentional passage of urine while awake.
Enuresis can also be divided into:
· Primary
· Secondary
Primary enuresis occurs in those children that have never had control over their diuresis during the night, while Secondary enuresis is where the child looses control of his diuresis after a period of at least 6 months of normal control.
Another classification for enuresis, which has recently been described in the literature, is based on the absence or presence of other symptomatology of instability of the bladder:
· Polysymptomatic enuresis: is associated a severe sensation of urgency, frequency and other symptoms that are linked to bladder instability.
· Monosymptomatic enuresis: has normal urination during the day.
The incidence of this disturbance in the population, according to the greater part of the authors, is from 15-20% at the age of 5, 5-7% at the age of 10 and 1-2% at the age of 15. Enuresis tends to resolve spontaneously with time; about 15% of those suffering from enuresis will spontaneously stop having bed wetting each year. By the age of 15, which is considered to be the limit for the physiological extinction, approximately 98-99% of the patients with enuresis will no longer have bed wetting. Primary Enuresis is more frequently seen in males than in females, ratio 3:2, but this ratio becomes 1:1 as the patients reach the adolescent age1.
For over a century, we have known that enuresis has a familial predisposition: ever since the 60’s, infact there are numerous epidemiological studies that have confirmed this fact. In Italy it has been seen that children coming from close relatives that have had enuresis, there can be an incidence of 60% of children with enuresis. Jarvelin has estimated that the risk to develop enuresis increases 5 to 7 times if the father or the mother had had enuresis. This risk increases to 10 times if both parents had enuresis. Miller, in 1999, had shown that children with a positive family history for enuresis responded better to treatment with desmopressin. From the familial studies, the research had passed on to investigate the genetic components, which however, is not been able to show the modality of transmission and which genes are involved. It is felt that there are four chromosomes which could be involved in the genesis of the disturbance: chromosome 13 in the region 13q13-13q14.2, chromosome 12 in the region 12q13, chromosome 8q and chromosome 22 in the region 22q11. In some families, it seems that the enuresis is inherited as an autosomal dominant trait 1 2 3.
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POSSIBLE CANDIDATES FOR ENURESIS |
Recent Italian research on 200 families with enuresis has
shown an elevated linkage, in the primary forms, with markers of chromosomes 8,
12, 13, and 22 1. It was also shown in a study of
Electroencephalograms that compared healthy children with those with primary
enuresis, that the presence of insufficient cerebral maturation is an important
pathogenic factor2. these data, which are reported in Chinese
Classical Energetics, makes us place attention to the Yuan points of the
principle meridians, in relation with the automated cerebral portion: Lung,
Large Intestine, Stomach and the Spleen meridians. Local points of interest
include, GV16, BL9 and GB19. being that it is necessary to tonify the points,
the distal and local points will always be treated on the left. Moxa can be
used to increase the action of the ancestral energy (Yuanqi*)1
2. at the ear level the points can be warmed with small incense sticks[*], the points of the cymba which correspond
to the Kidney and the Urinary[†],
found with the palpeur[‡]
250g/cm2 or glass rods[§], from the side which is the most
sensitive after palpating and auricular massage[1]
[2]. This treatment differs from that of TCM[3] [4] [5], as well as that proposed by various
European authors in the[6]. We
had treated, from Jan. 2002 to March 2003, three adolescents (2 males and a
female), having an age between 12 to 14 yrs. of age, each of which had a
minimum of three and a maximum seven episodes of bedwetting a week. All had a
diagnosis of primary enuresis without urogenital dysfunctions nor spina bifida.
There were carried out two treatment sessions of somatic – auricular therapy
each week, for a total of 10 weeks. Subsequently, follow up was done once a
month for 6 months. The results obtained are shown in the graph below.
the number of patients in our study are obviously inferior to those reported in recent studies[7] [8] even preliminary ones[9]. Nonetheless, this study can be considered as a pilot testing[10] for further and more wider research, which is better documented, even if a standard which is applied is different from that which is normally used[11].
Address for clarification
Carlo Di Stanislao
E-mail: amsaaq@tin.it
[1] Carmignola C., Speronello M.R., Zampieri F.: Auricoloterapia cinese. Guida a localizzazione, diagnosi e terapia, Ed. Istituto Prosa, Sperea (VE), 2003.
[2] Nogier P.: Introduzioone Pratica all’Auricoloterapia, Ed. Masson, Milano, 1999.
[3] Stux G., Berman B., Pomeranz B.: Basic of Acupuncture, 5th Edition, Ed. Verlag, Berlin, 2003.
[4] Ross J.: Combinazione dei punti di agopuntura, Ed.CEA, Milano, 1999.
[5] Bancrazi Alfio, Petti F., Liquori A.: Agopuntura: manuale energetico dei punti
Ed. Paracelo, Roma, 1999.
[6] Kespì J.M.: Cliniques, Ed. Guy Trèdaniel, Paris, 1989.
[7] Hu J. Acupuncture treatment of enuresis, J Tradit. Chin. Med., 2000, 20(2):158-160
[8] Bosson S., Lyth N.: Nocturnal Enuresis, Clin. Evid., 2002, 7: 341-348.
[9] Honjo H., Kawauchi A., Ukimura O., et al.: Treatment of monosymptomatic nocturnal enuresis by acupuncture: A preliminary study, Int. J. Urol., 2002, 9 (12):672-676.
[10] AAVV SAT-P Satisfication Profile, Ed. Erickson, Trento, 1998.
[11] Di Stanislao C., Palermo P., Porzio G., Konopacki D.: Riflessioni sulla medicina delle prove di efficacia. Ricadute nella creazione di gold-standard in agopuntura, La Mandorla (www.agopuntura.org), 2003, 25.