Nocturnal Enuresis and Rapid Maxillary Expansion
Condition: Nocturnal Enuresis
MeSH terms: Enuresis; Urinary Incontinence; Nocturnal Enuresis
Study type: Interventional

Summary: 
      Nocturnal enuresis (NE) is the involuntary loss of urine that occurs only at night in
      children aged 5 years or more.

      NE is a common problem, affecting about 10% of school children. The prevalence declines with
      each year of maturity but for some it persists in to adolescents and early adulthood. It can
      lead to bad self-confidence and low self-esteem, which can have psychosocial consequences.

      NE is a multifactorial condition. Three central factors have been identified:

      A) Many bedwetting children produce large amounts of urine at night due to a deficiency of
      the antidiuretic hormone vasopressin.

      B) Other children have a lack of inhibition of bladder emptying during sleep. C) Almost all
      children are deep sleepers with high arousal thresholds. They simply don't wake up when the
      bladder is full or when it contracts.

      There are two well established and evidence based treatments today: the bed-wetting alarm and
      the pharmacologic treatment desmopressin. The alarm emits a sound when the child wets the
      bed, which conditions the child to wake up or inhibit bladder emptying. This method is
      curative for about half of the patients who try this, but relapse occurs. Desmopressin is a
      synthetic analog of arginine vasopressin and works by decreasing the urine volume at night.
      About half of the patients become dry with this medication but only as long as they take the
      medicine. To day, at least 25% of all children with NE do not respond to any of the above
      treatment.

      Rapid maxillary expansion (RME) is a common orthodontic technique to treat patients with a
      narrow upper jaw. The brace is fitted by an orthodontist, and has a jack-screw, which is
      activated twice every day for 10-14 days. The procedure is neither painful nor harmful and is
      not very visible at all.

      There are a few reports about children who have become dry after RME treatment. None of them
      have been randomised or placebo controlled but indicates that quite a few children do become
      dry after this treatment. A recently carried out study in Sweden show that half of the
      children became dry after RME treatment. These children were all classed as therapy resistant
      and had already tried the alarm and medication without success.

      The reports are intriguing, but invite the question why a brace would help cure NE? It is
      likely that sleep and respiration is involved. This study will investigate these children's
      sleep during the treatment. The trial is a randomised, placebo controlled trial.
    


Intervention name(s): Rapid Maxillary Expansion; Placebo Appliance
Intervention type(s): Device; Device
Intervention description(s): The Rapid Maxillary Expander will over 10-14 days create a palatal expansion of about 5mm.; The Placebo Appliance looks exactly like the Rapid maxillary Expander but the expansion screw does not work. When the expansion screw is activated it does not create a palatal expansion.
Other intervention name(s): Hyrax screw; Sham Device
Allocation: Randomized
Intervention model: Single Group Assignment
Intervention model description: Rapid Maxillary Expansion
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Nocturnal Enuresis; Rapid Maxillary Expansion; Orthodontics; Polysomnography; Quality of life