Effectiveness of Carbamazepine in the treatment of refractory secondary enuresis: A case report

A 42-year-old woman was referred by neurology colleagues to our outpatient urology clinics. She presented with a non-monosymptomatic secondary enuresis, which started at 20 years of age When she was twenty-two she presented a single episode of a generalised tonic-clonic seizure, and she was treated with Carbamazepine (CBZ) with resolution of enuresis that reappeared when CBZ was stopped. Therefore, a video-EEG was performed, which documented an episode of enuresis during stage 1 of non-REM sleep without epileptic discharges and made it difficult for the patient to reach the deeper stages of sleep. According to these findings, the epileptic genesis of the enuresis was ruled out. A urodynamic invasive study was performed, and a normal active bladder associated with sleep disturbances was diagnosed as the combined cause of the non-monosymptomatic secondary nocturnal enuresis. Behavioural therapy and/or antimuscarinic treatments, alone or in combination, were used without success. Then the patient restarted CBZ at a low dose (200 mg/day), and a significant reduction of enuresis episodes (1 wet night every 9-10) was obtained with no changes in the bladder diary. CBZ effectiveness in such a case on an overactive bladder (OAB) could depend on its modulating effect in the central nervous system.