The treatment of enuresis for the children with severe neuro-psychic handicap through acupuncture PDF Print E-mail

(fotos - at the end of the page)

 

Floares Iuliu GP (Romania)

 

Ungureni Camin Spital from Bacau District is a home for severely handicapped children between 3 and 18 years of age; between 1995 and 1996 the number of children varied between 168 and 200, the number of girls and boys being almost equal(105 boys and 95 girls). The INCIDENCE of enuresis varied between 88% and 97.5% if we take into consideration the flow of admissions.  The incidence of enuresis is very big comparing with the medical literature that indicates 5% (Dellaret) or up to 41% (Verloti and other) (Professor Dr. Valeriu Popescu- Paediatric Treatise, third volume, Ed. Medicala, Bucuresti 1958, page 100-102). In case of neuro-psychiatric patients sometimes the enuresis coexists with day time incontinence and with urine and faeces incontinence (in unit:50-60%).

The treatment of enuresis remains a difficult problem in the allopathic medicine comparing with the traditional Chinese medicine, such as acupuncture, that gives very good results for a very long time, but it is little used.

THE PREMISE for starting the treatment with acupuncture on a group of children with neuro-psychiatric handicap was the supposition that it may well be that for these children the involuntary night mictuaretion (the enuresis) has a different energetic cause comparing with the day time involuntary mictuaretion.

One took into consideration the fact that the treatment with acupuncture has no unwanted side effects and so it can be applied without any risk.

OBJECTIVES: the attempt to cure or at least to improve the situation even for a small percentage of patients would have had the following effects:

- improving the patient's comfort;

- improving the specific microclimate in a unit of this type both for the clients and for the staff;

- lessening the wear of the linen and of the bedclothes.

THE GROUP of children with enuresis on which the treatment with acupuncture has been applied has 128 patients (63 girls and 65 boys) between 5 and 19 years old ( some of the children over 18 were not yet transferred to other units because of the formalities), the average age 12.8 years old, the amount of time since they have been admitted in Ungureni from 1 to 16 years old (with an average of 6 years).

From a neurological point of view, the group was formed of:

- 68 cases of chronical infantile encephalopathy;

- 22 cases of locomotion disorders, from which 2 cases of spastic paraplegia, 4 cases of paraparesis, 5 cases of severe malformation of the inferior limbs, 1 case of tetraparesis;

- 11 cases of epilepsia.

From a psychiatric point of view, the group was formed of:

- 7 cases of mental retardation first degree;

- 92 cases of mental retardation second degree;

- 29 cases of mental retardation third degree.

The majority of the cases had behaviour problems and there were 4 cases of autism among them.

Other illnesses associated: 11 cases of squint, 5 cases of festering chronic othitis, 1 case of ceciticy, 2 cases of compensated congenital heart malformation, 6 cases of AIDS or HIV carriers.

Due to the long distance up to the districtual hospital, one has given up paraclinical investigations.

The fact that the diagnosis were so severe and taking into consideration the prognosis, it was very difficult to establish an energetic diagnosis upon the traditional Chinese model, so I have chosen a general THERAPEUTIC FORMULA following the "Manual for Chinese Acupuncture" - Ed. Medicala, Bucuresti, 1982, page 166, priking the following points: RM4 (Guanyuan) + SP6 (Sanyinjiao) + S 36 (Zusanli) and V23 (Shenshu) + V28 (Pangguanshu) + V32 (Ciliao) in alternative sessions to which were sporadically added: the point of enuresis from auriculopuncture, the point of enuresis from hand acupuncture, the point of enuresis from instep acupuncture, and, not as often, R3 (Taixi), SP9 (Yinlingquan), V40 (Weizhong), VB34 (Yanglingquan), DM20 (Baihui), E.M. Waihuaijian (for incontinents) and E.M. Shenjiao.

The rhythm of these sessions was of 3-4 a week, for each case being used two series of 6-9 sessions (the majority of 10 sessions), and as a total were done 2513 acupuncture sessions (1352 in the first series and 1161 in the second series of treatment).

The results were monitored through evaluations done at 3,6,12 and 18 months followed by a general final evaluation consisting of daily observations for a month.

 

MAKING NOTES was done in a conventional way:

(-)     = for uninfluenced or weekly influenced enuresis;

(+)   = for intermittent enuresis with a sporadic frequency arround 50% of the nights of the month and diminution of the quantity;

(++)= for intermitent enuresis with scarce frequency of 3-5 nights a month = good result

(+++) = for cured enuresis = the absence of the night mictuaretion or 1-2  nocturnal mictuaretions per month = very good result

The treatment has started with a group of 10 girls between 11 and 19 years of age to which 10-15 sessions of acupuncture have been applied and a surprisingly good result has been obtained - six immediately cured cases, this was very encouraging and has determined the continuation of the therapy even if the good results have become rarer.  One has continued with patients whose age was bringing them close to the moment of their transfere to other units for adults (18 years old) and then one has formed groups of treatment with younger patients.

 

RESULTS OBTAINED

The result

Number of cases

Percentage

-

56

43.75%

+

35

27.34%

++

13

10.15%

+++

24

18.75%

 

The 37 case where good and very good results have been obtained, representing 28.90% from a group with this sort of problems have raised the interest for the ANALYSIS OF THE RESULTS within this presentation.

RESULTS ON GROUPS OF AGE

Age

Cases

-

+

++

+++

5-10 years old

60

34

16

7

3

10-14 years old

30

7

8

4

11

over 14 years old

38

15

11

2

10

 

One can establish that:

- within the group of 5-10 years old the best results

were obtained for 1/6 of the children(10) and that is

16.6%

- within the group of 10-14 years old 15 best results were obtained and that is 50%

- within the group of children over 14 years of age the 12 best results represent 31.5%  .

If one looks as well at the percentages of failure one can see that the percentage is bigger for the group of 5-10 years old (56%)comparing with those over 10 years of age (32%).

It is evident that in the case of this category of patients with neuro-psychiatric handicap one would prefer to start the treatment after 10 years of age.

Analysing the good and very good results as against the sex of the patients no differences can be seen in order to deserve mentioning

 

The sex

++

+++

Feminine

7

13

Masculine

6

11

 

RESULTS as against THE PSYCHIC DEFICIENCY :

Mental retardation

Results obtained (number of cases)

(degree)

-

+

++

+++

I

2

1

4

-

II

34

30

8

20

III

20

4

1

4

 

Good (++) and very good (+++) results have been obtained in 30.4% of the cases of mental retardation second degree as against the third degree of mental retardation were the percentage was 17.32% and this looks natural even if one has not took into consideration the aspect of cooperation.

One has also analysed the relation between the length of time of hospitalisation and the results:

- good results (marked with++) were obtained for children having 1to 10 years of hospitalisation with an average of 4.6 years;

- very good results(+++)were obtained for children having 1 to 16 years of hospitalisation with an average of 8.4 years.

One can then draw the following conclusion (that was expected): for this group of patients the stress induced by the hospitalisation has no influence over the treatment with acupuncture. Maybe this statement seems ill-timed but the stress generated by hospitalisation exists even for this patients and one has struggled to remove it creating a friendly and jolly atmosphere between the patients and the staff. One can give an example to picture this:

Observation number 26 : C.Adina, 11 years old, cronical  infantile encephalopathy , mental retardation second degree and autistic syndrome, no speech, has received 8 sessions of treatment with acupuncture and as no meare remission of the enuresis could be seen one has given up before the 10th session; one has experimented an improvement of the relation acupuncturist-patient by aiming to create an affective atmosphere, even if the diagnosis was not promising anything: sitting by the side of her bed, talking gently, caressing.  After 3-4 weeks the patient presented no enuresis! A second session of acupuncture has followed after one year due to a partial relapse (that was evident on the graphic of the bio-rhythm done for this study, during the critical and semicritical days  of the 3 endogene bio-rhythms). Final evaluation after 18 months = ++.

One must mention that the whole group that was treated with acupuncture has been studied in an experimental way in parallel with the evolution of their endogene bio-rhythms (physical, emotional and intellectual), even if one has supposed from the beginning that these are disturbed due to the complex handicap. Even if the analysis of this study may look unconvincing let us still look at it: from the total of 128 cases took in discussion, the bio-rhythm could be estimated only for those enuretics for whom pozitive results have been obtained, those were 72 cases, and from these a meare relation with the endogene bio-rhythms could be seen in 53 cases. No exact correlation has been established between the moment when the enuresis episodes appeared and the bio-rhythms, but one can present an estimate over the numerical coincidence of enuresis for all the patients :

- physical bio-rhythm  - critical day = 28 times

- semicritical day =19 times

- emotional bio-rhythm - critical day = 23 times

- semicritical day = 21 times

- intellectual bio-rhythms - critical day = 11 times

- semicritical day = 15 times

- combination of critical and semicritical day of two bio-rhytms = 34 times

Looking at the pozitive and negative semi-periods of the bio-rhythm curves the conclusions are even more difficult to be drawn but it looks as if the emotional bio-rhythm does influence(11 cases).

One should also take into consideration the incontinent patients as one has first said; from 128 cases 43 are incontinents:

 

 

Day time incontinence urine

 

Day time incontinence urine and faeces

Night time incontinence urine and faeces

Number of cases

14

26

3

Result obtained (cases)

(-)=10

(+)=2

(++)=2

(-)=15

(+)=7

(++)=1

(+++)=3

(-)=1

(+)=2

One can make some comments on the surprise of those healing children's day time urine and faeces incontinence:

- one case of a male chil, 16 years of age, mental retardation second degree, hospitalised for three years, coming from a hostile environment, could not be educated in such a short time(!)to control his sfincters;

- one female case, 19 years old, cronical infantile encephalopathy, spastic tetraparesis, mental retardation third degree, may have excuses;

- one male case, 8 years of age, mental retardation second dgree and HIV+, unconclusive.

The six neuropsychic handicapped children who had also AIDS (3) or are HIV+carriers (3) are aged between 3 and 9, 4 are male and 2 female, 5 have also daytime urine incontinence from which one has faeces incontinence too.

Results obtained :      (-)   = 4 cases

(+)   = 1 case

(+++) = 1 case

 

CONCLUSIONS

 

- Acupuncture may be applied successfully for enuresis even for children with sever neuro-psychic handicap, admitting a reasonably percentage of healing according to the situation these patients are in.

- It is better to apply the treatment with acupuncture for enuresis for neuro-psychic handicapped children after 10 years of age.


SUMMARY

 

128 children have been treated for enuresis with acupuncture between 1995 and 1996 in a home for severly neuro-psychic handicapped children, in Ungureni village, Bacau district. The patients age was between 5 and 19. One has chosen a general therapeutic formula applied in two series of 10 sessions each, on average, so the whole group has received 2513 sessions of acupuncture.Very good results have been obtained (healing) in 24 case (18.75%) (from which 3 cases of day time incontinence of urine and faeces) and intermitent enuresis with rare frequency in 13 cases (10.75%). The repartition has not been influenced by sex or the lenghth of time of hospitalization. One could see an aproximative corellation with the endogene bio-rhythms.

Conclusions: the treatment with acupuncture for enuresis for children with sever neoro-psychic handicap could give positive results; the treatment should be started after 10 years of age.

 

December 30th, 1996

 


The paper took part in the world contest with the occasion of the Fourth Conference on World Traditional Medicine, San Francisco, 1998, and was awarded the first prize. The paper was publishe in the Journal of World Traditional Medicine, vol 1, may 18th, 1998.

Diploma

 

Trofeu_1

 

Journal-of-Traditional-Medi