Functional connectivity of thalamus in children with primary nocturnal enuresis: results from a resting-state fMRI study

Functional connectivity density of brain in children with primary nocturnal enuresis: results from a resting-state fMRI study

Primary nocturnal enuresis (PNE) is a disease characterized by involuntary urination during sleep after the age of five, causing inconvenience and psychological burden to children and their families. The onset of PNE is related to many factors, and in recent years, delayed central nervous system maturation has been considered one of the important causes of PNE. Previous studies have demonstrated functional changes in multiple brain regions in children with PNE. However, these studies either focused on changes in local brain regions or the functional connection (FC) between specific brain regions, and there is currently a lack of research on the whole brain FC in children with PNE. This study analyzed functional connectivity density (FCD) across the entire brain based on voxels and comprehensively evaluated the global FCD (gFCD), local FCD (lFCD), and long-range FCD (lrFCD). Decreased gFCD and lFCD were found in the left temporal lobe and the right posterior cerebellum in the children with PNE compared with the HC. The FCD values in these regions were negatively correlated with the scores of hyperactivity/impulsivity in the children with PNE. This study may help to reveal the neural mechanisms underlying the onset of PNE in children from a new perspective.

Management of a Complex Case of Primary Enuresis in an Adult With Attention-Deficit Hyperactivity Disorder: A Case Report

Enuresis is the inability to maintain voluntary control over urination, which is a relatively uncommon condition in adults. Therefore, there is limited research exploring the management of primary enuresis in adult patients with comorbid attention-deficit hyperactivity disorder (ADHD), particularly in the Middle Eastern region. We report the case of a 28-year-old female patient who has been following up and treated for comorbid bipolar affective disorder (BAD) and borderline personality disorder (BPD) for 12 years, complicated with primary enuresis. She was treated with 10 mg oral escitalopram once daily and a monthly intramuscular injection of 400 mg aripiprazole extended-release, with no reported improvement in her symptoms. Upon recent comprehensive reassessment, the patient was found to have a missed diagnosis of ADHD. Along with her current medications, she was started on 18 mg methylphenidate once daily and lamotrigine, started by 25 mg once daily, titrated to 50 mg. This adjustment led to significant improvement in her symptoms and the resolution of her enuresis. This case report demonstrates the resolution of ADHD symptoms along with the primary enuresis in an adult female patient who was treated with methylphenidate.

The Resting-State Activities of the Angular Gyrus and the Micturition Desire-Awakening Function in Children With and Without Enuresis

BACKGROUND

Micturition desire-awakening (MDA) function plays a pivotal role in the development of primary nocturnal enuresis (PNE); however, its neural correlates remain largely unexplored. Consequently, this study aimed to identify specific brain regional activities associated with MDA function.

METHODS

Neuroimaging data were collected from 173 children with varying MDA functional grade scores at the Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, from July 2018 to November 2022. Resting-state images were analyzed using whole-brain correlation techniques and AlphaSim correction to identify brain regional activities and resting-state functional connectivity (RSFC) associated with MDA functional grade scores.

RESULTS

Whole-brain correlation analysis demonstrated that the fractional amplitude of low-frequency fluctuations in the right angular gyrus (AG) exhibited a negative correlation with MDA functional grade scores (rs = -0.336, p < 0.001), indicating reduced neural activity in this region with MDA dysfunction. Conversely, RSFC between the right middle frontal gyrus and the right AG was positively correlated with MDA functional grade scores (rs = 0.274, p < 0.001), suggesting increased connectivity in these areas associated with worse MDA functionality.

CONCLUSION

These findings provide preliminary insights into the neural underpinnings of MDA functionality.

Functional connectivity alterations in the thalamus among patients with bronchial asthma

Objective

Bronchial Asthma (BA) is a common chronic respiratory disease worldwide. Earlier research has demonstrated abnormal functional connectivity (FC) in multiple cognition-related cortices in asthma patients. The thalamus (Thal) serves as a relay center for transmitting sensory signals, yet the modifications in the thalamic FC among individuals with asthma remain uncertain. This research employed the resting-state functional connectivity (rsFC) approach to explore alterations in thalamic functional connectivity among individuals with BA.

Patients and methods

After excluding participants who did not meet the criteria, this study finally included 31 patients with BA, with a gender distribution of 16 males and 15 females. Subsequently, we recruited 31 healthy control participants (HC) matched for age, gender, and educational background. All participants underwent the Montreal Cognitive Assessment (MoCA) and the Hamilton Depression Rating Scale (HAMD) assessment. Following this, both groups underwent head magnetic resonance imaging scans, and resting-state functional magnetic resonance imaging (rs-fMRI) data was collected. Based on the AAL (Automated Anatomical Labeling) template, the bilateral thalamic regions were used as seed points (ROI) for subsequent rsFC research. Pearson correlation analysis was used to explore the relationship between thalamic functional connectivity and neuropsychological scales in both groups. After controlling for potential confounding factors such as age, gender, intelligence, and emotional level, a two-sample t-test was further used to explore differences in thalamic functional connectivity between the two groups of participants.

Result

Compared to the HC group, the BA group demonstrated heightened functional connectivity (FC) between the left thalamus and the left cerebellar posterior lobe (CPL), left postcentral gyrus (PCG), and right superior frontal gyrus (SFG). Concurrently, there was a decrease in FC with both the Lentiform Nucleus (LN) and the left corpus callosum (CC). Performing FC analysis with the right thalamus as the Region of Interest (ROI) revealed an increase in FC between the right thalamus and the right SFG as well as the left CPL. Conversely, a decrease in FC was observed between the right thalamus and the right LN as well as the left CC.

Conclusion

In our study, we have verified the presence of aberrant FC patterns in the thalamus of BA patients. When compared to HCs, BA patients exhibit aberrant alterations in FC between the thalamus and various brain areas connected to vision, hearing, emotional regulation, cognitive control, somatic sensations, and wakefulness. This provides further confirmation of the substantial role played by the thalamus in the advancement of BA.

Abnormal resting-state functional connectivity of hippocampal subregions in children with primary nocturnal enuresis

Objective

Previous neuroimaging studies have shown abnormal brain-bladder control network in children with primary nocturnal enuresis (PNE). The hippocampus, which has long been considered to be an important nerve center for memory and emotion, has also been confirmed to be activating during micturition in several human imaging studies. However, few studies have explored hippocampus-related functional networks of PNE in children. In this study, the whole resting-state functional connectivity (RSFC) of hippocampus was investigated in children with PNE.

Methods

Functional magnetic resonance imaging data of 30 children with PNE and 29 matched healthy controls (HCs) were analyzed in our study. We used the seed-based RSFC method to evaluate the functional connectivity of hippocampal subregions defined according to the Human Brainnetome Atlas. Correlation analyses were also processed to investigate their relationship with disease duration time, bed-wetting frequency, and bladder volume.

Results

Compared with HCs, children with PNE showed abnormal RSFC of the left rostral hippocampus (rHipp) with right fusiform gyrus, right Rolandic operculum, left inferior parietal lobule, and right precentral gyrus, respectively. Moreover, decreased RSFC of the left caudal hippocampus (cHipp) with right fusiform gyrus and right supplementary motor area was discovered in the PNE group. There were no significant results in the right rHipp and cHipp seeds after multiple comparison corrections. In addition, disease duration time was negatively correlated with RSFC of the left rHipp with right Rolandic operculum (r = -0.386, p = 0.035, uncorrected) and the left cHipp with right fusiform gyrus (r = -0.483, p = 0.007, uncorrected) in the PNE group, respectively. In the Receiver Operating Characteristic (ROC) analysis, all the above results of RSFC achieved significant performance.

Conclusions

To our knowledge, this is the first attempt to examine the RSFC patterns of hippocampal subregions in children with PNE. These findings indicated that children with PNE have potential dysfunctions in the limbic network, sensorimotor network, default mode network, and frontoparietal network. These networks may become less efficient with disease duration time, inducing impairments in brain-bladder control, cognition, memory, and emotion. Further prospective research with dynamic observation of brain imaging, bladder function, cognition, memory, and emotion is warranted.

Altered resting-state functional connectivity of insula in children with primary nocturnal enuresis

Objective

Primary nocturnal enuresis (PNE) is a common developmental condition in school-aged children. The objective is to better understand the pathophysiology of PNE by using insula-centered resting-state functional connectivity (rsFC).

Methods

We recruited 66 right-handed participants in our analysis, 33 with PNE and 33 healthy control (HC) children without enuresis matched for gender and age. Functional and structural MRI data were obtained from all the children. Seed-based rsFC was used to examine differences in insular functional connectivity between the PNE and HC groups. Correlation analyses were carried out to explore the relationship between abnormal insula-centered functional connectivity and clinical characteristics in the PNE group.

Results

Compared with HC children, the children with PNE demonstrated decreased left and right insular rsFC with the right medial superior frontal gyrus (SFG). In addition, the bilateral dorsal anterior insula (dAI) seeds also indicated the reduced rsFC with right medial SFG. Furthermore, the right posterior insula (PI) seed showed the weaker rsFC with the right medial SFG, while the left PI seed displayed the weaker rsFC with the right SFG. No statistically significant correlations were detected between aberrant insular rsFC and clinical variables (e.g., micturition desire awakening, bed-wetting frequency, and bladder volume) in results without global signal regression (GSR) in the PNE group. However, before and after setting age as a covariate, significant and positive correlations between bladder volume and the rsFC of the left dAI with right medial SFG and the rsFC of the right PI with right medial SFG were found in results with GSR in the PNE group.

Conclusion

To the best of our knowledge, this study explored the rsFC patterns of the insula in children with PNE for the first time. These results uncovered the abnormal rsFC of the insula with the medial prefrontal cortex without and with GSR in the PNE group, suggesting that dysconnectivity of the salience network (SN)-default mode network (DMN) may involve in the underlying pathophysiology of children with PNE. However, the inconsistent associations between bladder volume and dysconnectivity of the SN-DMN in results without and with GSR need further studies.

The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study

Primary nocturnal enuresis (PNE) affects children's physical and mental health with a high rate. However, its neural mechanism is still unclear. Studies have found that the paraventricular thalamus (PVT) is among the key brain regions implicated with awakening regulation and its control of the transition between sleep and wakening is dependent on signaling through the PVT-nucleus accumbens (NAc) pathway. So this study analyzed the function of brain regions and their connectivity of PVT and NAc. A total of twenty-six PNE and typically developing (TD) children were involved in the study and the methods of amplitude of low frequency fluctuation (ALFF), degree centrality (DC) and functional connectivity (FC) based on resting-state functional magnetic resonance imaging (rs-fMRI) were used to analyze the brain functions. Results showed that there was no statistical significant difference in ALFF and DC between PNE and TD children in bilateral PVT and NAc. And there was statistical significant difference of the comparison of the FC of left PVT (lPVT) and left NAc (lNAc) between PNE and TD children. Meanwhile, there was negative correlation between awakening score and the FC of rPVT and lNAc, and no obvious correlation between awakening score and the FC of lPVT and lNAc in PNE children. Meanwhile, there was both negative correlation between awakening score and the FC of lPVT, rPTV and lNAc in TD children. Therefore, the FC between rPVT and lNAc was more reliable in assessing the degree of awakening ability in PNE children. This finding could help establish the evaluation index of PNE.

Frequency-specific alterations of the resting-state BOLD signals in nocturnal enuresis: an fMRI Study

Resting state functional magnetic resonance imaging studies of nocturnal enuresis have focused primarily on regional metrics in the blood oxygen level dependent (BOLD) signal ranging from 0.01 to 0.08 Hz. However, it remains unclear how local metrics show in sub-frequency band. 129 children with nocturnal enuresis (NE) and 37 healthy controls were included in this study. The patients were diagnosed by the pediatricians in Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, according to the criteria from International Children's Continence Society (ICCS). Questionnaires were used to evaluate the symptoms of enuresis and completed by the participants. In this study, fALFF, ReHo and PerAF were calculated within five different frequency bands: typical band (0.01-0.08 Hz), slow-5 (0.01-0.027 Hz), slow-4 (0.027-0.073 Hz), slow-3 (0.073-0.198 Hz), and slow-2 (0.198-0.25 Hz). In the typical band, ReHo increased in the left insula and the right thalamus, while fALFF decreased in the right insula in children with NE. Besides, PerAF was increased in the right middle temporal gyrus in these children. The results regarding ReHo, fALFF and PerAF in the typical band was similar to those in slow-5 band, respectively. A correlation was found between the PerAF value of the right middle temporal gyrus and scores of the urinary intention-related wakefulness. Results in other bands were either negative or in white matter. NE children might have abnormal intrinsic neural oscillations mainly on slow-5 bands.

Pathogenesis and brain functional imaging in nocturnal enuresis: A review

Nocturnal enuresis is a common and distressing developmental disease, which may cause various degrees of psychosocial stress and impairment to self-esteem in affected children as well as agitation to their parents or caregivers. Nevertheless, the etiology and pathogenesis of nocturnal enuresis are not understood. Currently, nocturnal enuresis is generally considered a multifactorial disease associated with a complex interaction of somatic, psychosocial, and environmental factors. A variety of postulations have been proposed to explain the occurrence and progression of nocturnal enuresis, including hereditary aberration, abnormal circadian rhythm of antidiuretic hormone secretion during sleep, bladder dysfunction, abnormal sleep, difficulties in arousal, neuropsychological disorders, and maturational delays of the brain. In recent decades, the introduction of functional neuroimaging technologies has provided new approaches for uncovering the mechanisms underlying nocturnal enuresis. The main neuroimaging modalities have included brain morphometry based on structural magnetic resonance imaging (MRI), task-based and event-related functional MRI (fMRI), and resting-state fMRI. The relevant studies have indicated that nocturnal enuresis is associated with functional and structural alterations of the brain. In this review, we briefly summarized the popular hypotheses regarding the pathogenesis of nocturnal enuresis and the current progress of functional neuroimaging studies in examining the underlying mechanisms thereof.

Sleep Monitoring of Children With Nocturnal Enuresis: A Narrative Review

The purpose of this article is to provide a succinct summary of the sleep monitoring efforts that have been used in nocturnal enuresis (NE) and an overview of the knowledge that has accrued. This is not intended to be a comprehensive review, but rather is intended to highlight how polysomnography (PSG), a common sleep detection tool, has contributed to our understanding of NE, as arousal disorder is considered to be one of the important mechanisms. The authors have organized this report by analysis and display of different ingredients of PSG, starting with comparing the electroencephalogram (EEG) of controls and the enuretic children and then moving to evaluation of respiratory patterns of NE and comorbid disease obstructive sleep apnea (OSA). In addition, the authors' goal is to better understand the mechanism of NE by integrating various levels of sleep monitoring; those sleep-related clinical scale scores for NE are presented to date. Finally, we propose further research of NE to explore the microstructure alterations via PSG combined with EEG-fMRI or to use novel technology like portable device internet and deep learning strategy.