A visual motor psychological test as a predictor to treatment in nocturnal enuresis.

BACKGROUND AND AIMS The neurological control of bladder function and the ability to be dry at night involves not only the acquisition of normal daytime control, but also the establishment of a circadian rhythm in vasopressin release and the ability to arouse to a full bladder during sleep. We postulated that in some children there might be a delay in maturation of the normal neurological pathways involved in establishment of nocturnal continence and examined this by using a specific neuropsychological test. METHODS Children attending an established nocturnal enuresis clinic were examined using the Rey-Osterrieth test to assess the presence or absence of boundary errors in both copy and memory reproductions. The results of the test were scored independently and blind to the response to treatment with the vasopressin analogue DDAVP. RESULTS A significant association was found between boundary type errors and response to DDAVP, with non-responders making significantly more errors. No child with three or more errors responded to DDAVP. Using this test, the ability to predict response to treatment was 70%. CONCLUSIONS It is postulated that the Rey-Osterrieth test, through the presence or absence of boundary errors, reflects a delay in maturation and/or a disorganisation of the retinal-hypothalamic-cortical pathways in the brain. The association previously described with growth hormone neurosecretory dysfunction syndrome would be compatible with this.