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Intensive playing leads to non-monosymptomatic enuresis in children with low prepulse inhibition



Sebastian Schulz-Juergensen, Allgemeine Pädiatrie, UKS-H, Campus Kiel, Haus 9, Schwanenweg 20, 24105 Kiel, Germany. Tel: +49 431 597 1622 | Fax: +49 431 597 5107 | Email:



Parents of children suffering from non-monosymptomatic enuresis (nmE) report their child wetting itself during intensive playing. As children with enuresis are characterized by reduced bladder control (measured as prepulse inhibition (PPI) of startle reflex), the hypothesis suggests that intensive playing leads to further decrease in control and consecutive wetting. Two questions are important: Does PPI change while concentrating? Is this difference more explicit in children with daytime incontinence?


Forty-four healthy children, 40 children with nmE and 37 with monosymptomatic enuresis (mE) were examined. PPI was measured while watching DVD and while playing Nintendo's Wii®, and calculated as percentage of the native startle response.


All probands showed a relevant decrease in PPI: in relaxed state, the PPI of the controls was 54%; when concentrating, it fell to 34.5% (p = 0.014). The decrease in PPI in mE was from 66% to 51% (p = 0.008), and the decrease in PPI in nmE was from 29% to 21% (p = 0.125).


While the decrease in PPI when playing was smallest in the group with nmE, overall PPI level was by far the lowest. The findings confirm the aetiology of enuresis through impaired ‘sensori-motor gating’ in children with nmE and provide a neurophysiologic correlate for wetting while playing.