Application of Dynamic Electric Neurostimulation

Application of Dynamic Electric Neurostimulation for Treatment of Urinary Bladder Neurogenic Dysfunction in Children

Khan M.A. 1, Borovitskiy I.P. 1, Malakhov V.V.2, Chernyshev V.V.2, Novikova E.V.1, Vakhova E.L. 1
1 Scientific Center for Restorative and Resort Medicine RAMS, Moscow.
2 Medical department of “DENAS MS” Corporation, Yekaterinburg.

High therapeutic effectiveness of dynamic electric neurostimulation (DENS) delivered by DENAS apparatus for treatment of urinary bladder neurogenic dysfunction and enuresis in children was observed. In case of urinary bladder neurogenic dysfunction, efficiency of treatment in children receiving DENS averaged 80%, while cure rate of patients with conventional management (the control set) formed olny 40 %. In case of enuresis, efficiency of treatment in patients receiving DENS achieved 90 %, as compared with 60 % in the control set.
Key words: urinary bladder neurogenic dysfunction, enuresis, dynamic electric neurostimulation.

Prevailing among the children diseases, enuresis becomes the issue of the day. It’s hard to believe, but more than half a billion people suffered from enuresis by the end of the 20th century. According to various authors (1), incidence of enuresis in children between 4 to 15 years old ranges from 10 % to 40 %. The overwhelming majority of children who experience enuresis overcome this disease when growing up. But as much as 8-10 % of children and 1% of adults can’t deal with the disease. Enuresis becomes a social problem and causes mindedness that makes a negative impact on mental condition and social adaptation. (4)

The economic aspects of enuresis treatment arrangement are rather important. Relief action, diagnostics, treatment and vindication of patients requires significant costs. It is proved that enuresis has multifactorial nature, thus the disease should be considered as a group of pathological states with various ethiology. The most common (80-90 %) is primary enuresis. Children who experience this type of the disease don’t typically have any complications. Various authors consider that in 1-10 % of cases urological pathology plays a definite role in the contraction of enuresis (3). A lot of authors both native and foreign point out that secondary enuresis is more likely to occur after the urinary bladder functional disturbance, based on neurohumoral regulation imbalance and bladder hypoxia. Typical clinical presentations of the secondary enuresis are urinary discomfort in the form of the urge syndrome (i.e. pollakiuria, imperative feeling, imperative urinary incontinence, and enuresis). These processes are followed by severe urodynamics disturbance of functional and obstructive type and participate in cystitis, pyelonephritis and vesicoureteral reflux formations (4, 7, 8).

Today significant success is achieved in enuresis treatment. Such methods as dietotherapy, psychotherapy, bed wetting alarms, and pharmacotherapy (with hormone analogues, M-cholinergic receptor antagonist, antidepressant, and respiratory analeptics application) are widely used. However, complexity of pathogenesis, therapy resistance and gravity of chemicals explain the urgency of the research and demand development of new pathogenetically founded and non-pharmacotherapy methods.

Use of physiotherapy in enuresis treatment always was rather observable. Among the most effective methods of physiotherapy one should point out the medicine electrophoresis, laser therapy, ultrasound, and electric stimulation. However, today the preference in treatment is given to the impulse current. The impulse current allows drawing more high-grade sensitivity as compared with continuous wave operation, and reducing the rate of energetic stimulation, what is of high importance for growing organism.

In pediatrics a priority use of physical factors of low intensity, low-power, and pulse sequence is generally explained by the physical therapeutic response. Peculiarities of physical therapeutic response demonstrated by children are a result of more delicate nervous system, more intensive metabolic and reparative processes (1,3).

Dynamic electric neurostimulation (DENS) is one of the safest and most effective methods of impulse excitation. An inestimable advantage of DENS is that the method delivers dynamically changing impulses, impulse shape and frequency being similar to the internal action potential of a human (2). This and some other peculiarities of the DENS allow to increase efficiency of treatment and produce more stable effect (5,6).

Pediatric nephrology possesses only rear examples of the dynamic electric neurostimulation application (7,8). The use of this method for urinary bladder neurogenic dysfunction and enuresis treatment has not yet been scientifically reasoned. Thus, development of treatment techniques with account of clinical form of a disease, age of a child, and co-morbidity is a highly topical issue.

Patients and Methods

The group of 60 children and teenagers (from 5 to 15 years old) suffering from the urinary bladder neurogenic dysfunction and enuresis was put into clinical observation and special research. 40 children were delivered the dynamic electric neurostimulation, and 20 of them made up the control set (without physiotherapy).
The dynamic electric neurostimulation was delivered by the “DENAS” apparatus. The children demonstrated high tolerability of the method, no side effects being discovered.
The dynamic electric neurostimulation method was applied to the treatment of incontinence of urine in children in accordance to the guidelines and requirements described the literature of the subject (6). The data introduced in Table 1 and Table 2 characterizes application of the DENS method to the urinary bladder neurogenic dysfunction treatment and enuresis treatment respectively. In case of vesicoureteral reflux additional stimulation was provided for frontal view zones of ureters from the sides of abdominal wall and back. In the case of pyelonephritis, the longest stimulation was provided for paravertebral zone on the level of kidneys projection (Th11-L3). The course of treatment included 10-12 sessions a day.

Table 1


Dynamic electric neurostimulation procedures for treatment of urinary bladder neurogenic dysfunction in children

Impact area Modality Energy range Regime Time of exposure (minutes)
5-7 years old 8-11 years old 12-15 years old
Paravertebralzone (Th1-L3 level) Instable  along the spine: from the neck to the lower back ER-2 (Comfortable) Therapy 77 Hz 5 7 10
Zone of urinary bladder frontal projection Instable or stable ER – 2 for children under 10 years; ER-3 for children over 10 years (maximal ER is applied according to the patient tolerance) Therapy 77 Hz 4 5 7


Table 2

Dynamic electric neurostimulation procedures for treatment of enuresis in children

Impact area Modality Energy range Regime Time of exposure (minutes)
5-7 years old 8-11 years old 12-15 years old
Paravertebral zone (C71-L2 level) Instable along the spine: from the neck to the lower back ER-2 (Comfortable) Therapy 77 Hz 5 7 10
Zone of urinary bladder frontal projection Instable or stable ER – 2 for children under 10 years; ER-3 for children over 10 years (maximal ER is applied according to the patient tolerance) Therapy 77 Hz 4 5 7

Results

The conducted research showed that Dynamic electric neurostimulation makes positive influence on clinical presentation and urodynamic indexes in children experiencing the urinary bladder neurogenic dysfunction. The first set of DENS sessions resulted in decreasing frequency of nocturnal and day enuresis and less frequent pains in the urinary bladder. By the end of the treatment course more than 80% of children were promoted to positive and permanent dynamics of clinical signs, the rate of involuntary urinations varying within normal limits. An average effective volume of urinary bladder increased in 80 % of patients with (гиперрефлекторная)urinary bladder dysfunction. 
The number and frequency of urinations per day decreased simultaneously. 
Sessions of the DENS therapy were also followed by the clear tendency to normalization of humoral immunity in children with concomitant inflammatory disease of the urogenital system, 
Under the influence of the DENS significant improvements of clinical presentations in children with nocturnal enuresis were observed. The DENS resulted in decreasing the frequency of nocturnal bedwetting and elimination of the urge syndrome in children with concomitant neurogenic dysfunction of the urinary bladder.

Improvements of the urge syndrome were followed by positive changes of psychoemotional state, as evidenced by decreased irritation, headaches, and sleep disturbance in overwhelming majority of children with nocturnal enuresis (66, 7%). Subsequent to the results of the testing the number of children with high anxiety level and enhanced emotional lability declined, while the quantity of children with self-acceptance increased.

The course of the DENS treatment has also demonstrated positive influence on all types of vegetative disorders in children with nocturnal bedwetting. In accordance with the cardiography data a higher activity of humoral heart rate regulation, improvements of cardiac performance in majority of children with enuresis were observed.

The results achieved in clinical trials and laboratory studies allow establishing high therapeutic effectiveness of dynamic electric neurostimulation for treatment of urinary bladder neurogenicdysfunction and enuresis in children. Cure rates of the urinary bladder neurogenic dysfunction and enuresis averaged 80% and 90 %, respectively, while cure rates of the control set formed 40 % for urinary bladder neurogenic dysfunction and 60 % for enuresis.

Conclusion

Thus, on the basis of the conducted research the following can be concluded:
The use of dynamic electric neurostimulation is effective and expedient for treatment of the urinary bladder neurogenic dysfunction and enuresis in children.

The use the dynamic electric neurostimulation results in improvement of urination, i.e. decreasing frequency of bedwetting, elimination of the urge syndrome and normalization of urodynamics.
Pain (cystodynia) relief in children with the urinary bladder neurogenic dysfunction allows establishing the analgesic end point of the DENS. Application of the DENS has positive influence on the vegetative nervous system. The number of children with vegetative disregulation, hypersympathicotonic and asympathicotonic types of autonomic reactivity decreased. The use of the DENS paralleled the improved thermoregulation in patients.

Under the influence of the DENS significant improvement in emotional state of the patients were observed.
High efficiency of dynamic electric neurostimulation, high tolerability of the treatment, availability of domestic equipment allows recommending application of the DENS for treatment of children with the urinary bladder neurogenic dysfunction and enuresis (the treatment may be delivered at polyclinic, hospital, health centre, or convalescent center).

Literature

1. Vishnevskiy E.L. Diagnostics and treatment of urinary bladder neurogenic dysfunction in children// Pediatrics. 1997. № 3. p. 42-44. (in Russian)

2. Chernyshev V.V., Rjavkin A.Y., Malakhov V.V. and others. Dynamic electric neurostimulation: Method and Recomendations. Moscow, 2005. p. 32. (in Russian)

3. Kirillov V.I., Kireeva N.G. Urinary bladder neurogenic dysfunction in children // Russian medical journal. 1998. № 9. p. 587-593. (in Russian)

4. Klekovkina N.I., Safronov A.A., Rjavkin A.Y. Dynamic electric neurostimulation in multimodality therapy of children with non-psychotic disorders. // “DENS Faculty” Archive of Scientific-Practical Works . V. II. Application of DENS-therapy in Pediatrics. Yekaterinburg, 2004. p. 90-91. (in Russian)

5. Andreeva E.I. and others. Clinical Picture and Treatment of Enuresis inchildren: Method and Recomendations. М., 1977. 18 p. (in Russian)

6. Chernyshev V.V., Malakhov V.V., Vlasov A.A. and others. Manual for Dynamic Electric Neurostimulation Treatment with DENAS apparatus. Arranged edition. Yekaterinburg, 2002. 284 p. (in Russian)

7. Semenov A.V. Use of DENS-therapy in Pediatric Urology Department for threatment urinary system impairements in children. // Materials of International Symposium, «Dynamic Electric Stimulation Method». Yekaterinburg, 2003. p.152-156. (in Russian)

8. Stolpovskaja O.K. Experience of Dynamic Electric Stimulation Method for treatment enuresis with children// Materials of International Symposium, «Dynamic Electric Stimulation Method». Yekaterinburg,, 2004. p. 1 70-171. (in Russian)

9. Chuprina R.N. Theoretical Approach to Application and Efficiency Enhancement of Dynamic Electric Stimulation Method // Materials of International Symposium, «Dynamic Electric Stimulation Method». Yekaterinburg, 2004. p. 53-55. (in Russian)

Scroll to top