Cessation of Nocturnal Enuresis after Intervention with Methylcobalamin in an 18-Year-Old Patient with Autism

Abstract

[Author Affiliation]Adela Corejova. 1 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic.Daniela Janosikova. 2 Department of Psychology, Faculty of Philosophy and Arts, Trnava University, Slovak Republic.Veronika Pospisilova. 3 Autism Centre Andreas, Bratislava, Slovak Republic.Drahomira Rauova. 4 Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy of Comenius University, Bratislava, Slovak Republic. 5 Toxicological and Antidoping Centre, Comenius University, Bratislava, Slovak Republic.Jan Kyselovic. 1 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic.Anna Hrabovska. 1 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic. 5 Toxicological and Antidoping Centre, Comenius University, Bratislava, Slovak Republic. 6 Biomedical Research Center, University Hospital, Hradec Kralove, Czech Republic.*These authors participated equally in project supervision.Funding: This work was financially supported by The Ministry of Education, Science, Research, and Sport of the Slovak Republic (VEGA) grant 1/1139/12, the Slovak Research and Development Agency (APVV) grant SK-FR-0048-11, and the European Regional Development Fund, Research and Development Operational Program Grant to the Centre of Excellence for Glycomics, ITMS 26240120031.Address correspondence to: Anna Hrabovska, PharmD, PhD, Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Odbojarov 10, 832 32 Bratislava 3, Slovak Republic, E-mail: anna.hrabovska@gmail.comTo The Editor:Nocturnal enuresis, incontinence in discrete episodes while asleep, is one of the most common disorders among children (Neveus et al. 2006). It is a multifactorial disorder. Several risk factors have been described so far, including developmental delay, as well as genetic and psychosocial factors (Butler 2004; Caldwell et al. 2005). Clinical categorization distinguishes monosymptomatic enuresis, which is usually linked to the abnormal nocturnal vasopressin release or polyuria, and non-monosymptomatic enuresis caused by bladder dysfunction or overactivity (Butler 2004; Deshpande and Caldwell 2012; Naseri and Hiradfar 2012).Children with developmental delay and other neurological disorders often develop nocturnal enuresis (Jarvelin 1989; Simonoff et al. 2008; Zhao et al. 2009; Gor et al. 2012; Nappo 2012). The treatment of enuresis in these patients is more difficult because of psychological and behavioral changes. Pharmacological intervention using desmopressin and anticholinergic drugs is questionable, because of the mixed outcomes from the treatment (Naitoh et al. 2005; Yucel et al. 2011; Gor et al. 2012), as well as severe side effects (Muller et al. 2004; Gish et al. 2009; Friedman et al. 2011).Here, we report a case of disappearance of nocturnal enuresis in an 18-year-old patient with childhood autism after oral application of a low dose of methylcobalamin. The patient was enrolled in the study to examine the effect of methylcobalamin on the psychobehavioral profile in patients with autism.Case ReportWe present the case of an 18-year-old male (J.N.) with the primary diagnosis childhood autism (F84.0, from the International Statistical Classification of Diseases and Related Health Problems [ICD], 10th revision, Classification of Mental and Behavioral Disorders) (World Health Organization [WHO] 2003). The assessment was conducted by a pediatric and adolescent clinical and educational psychologist, using objective diagnostic methods (Autism Diagnostic Interview-Revised [ADI-R] [Rutter et al. 2003] and Childhood Autism Rating Scale [2-CARS] [Schopler et al. …