Maprotiline effects in children with enuresis and behavioural disorders

• 1.

  1. To determine the efficacy and safety of maprotiline (Ludiomil) in children with functional enuresis and behavioural disorders, 12 patients (mean age, 9 yrs 4 mos) participated in an open trial consisting of baseline evaluations (4 weeks) followed by maprotiline therapy (8 weeks) and post-drug follow-up (4 weeks). Nine of these patients had moderate or greater degrees of behavioural problems; in 5 enuresis appeared resistant to previous antienuretic medication. Two patients had encopresis.

• 2.

  2. Evaluations included paediatric and psychiatric assessments; parents' ratings of behaviour, enuresis and sleep; clinical laboratory tests; EKGs and measurements of vital signs. The initial daily dose of maprotiline was 10 mg, the maximum 75 mg, and the mean during the final week 63 mg.

• 3.

  3. Compared to baseline, with maprotiline therapy enuresis improved in 11 patients (range 7–100%; mean, 32%) and worsened in one (25%). Encopresis significantly improved in 2 patients. Clinical global improvement was marked in 3 patients, moderate in 6, slight in 2, and absent in one. Clinical and parents' assessments indicated improvements of hyperkinetic, conduct and sleep problems.

• 4.

  4. Adverse effects were infrequent and mild. Heart rate and blood pressure means slightly increased with maprotiline, but all vital signs and EKGs remained within normal limits. Maprotiline was well tolerated and accepted.

• 5.

  5. Four weeks following maprotiline withdrawal, there was further improvement of enuresis in 4 patients and of behaviour in 2, enuresis relapsed in 6 patients and behaviour in 5, while behaviour was unchanged in 5 patients.

• 6.

  6. Our data suggest that maprotiline is effective and safe in the therapy of children with enuresis and behaviour disorders. Controlled trials are indicated.