Neurophysiological and Neurobehavioral Phenotypes in Children with Nocturnal Enuresis: Findings from a Large Clinical Cohort

Introduction: Nocturnal enuresis is increasingly recognized as a heterogeneous developmental condition in which impaired arousal and maturation of central regulatory mechanisms may coexist with neurobehavioral difficulties. We aimed to characterize the spectrum of neurophysiological and neurobehavioral features in children with nocturnal enuresis.

Methods: This observational clinical cohort included 273 children aged 5–18 years with nocturnal enuresis. Participants underwent standardized neurological assessment and electroencephalography (EEG). EEG recordings were evaluated for age-appropriate background organization, maturational abnormalities, alpha-rhythm alterations, hypersynchronous activity, and diffuse changes. Neurobehavioral assessment included symptoms of attention-deficit/hyperactivity disorder (ADHD), anxiety or psycho-emotional tension, and reduced self-confidence. EEG features were not considered mutually exclusive. Data were analyzed descriptively using absolute and relative frequencies.

Results: The cohort comprised 168 boys (61.5%) and 105 girls (38.5%). Age-appropriate EEG organization was observed in 138 children (50.5%), while approximately 32% showed delayed or altered age-related organization of background activity. Alpha-rhythm alterations were identified in 79%, including hypersynchronous alpha activity in 37%, and diffuse EEG changes were present in 25%. ADHD symptoms were documented in 20.9% of participants, anxiety or psycho-emotional tension in 12.5%, and reduced self-confidence in 9.5%. Neurophysiological deviations and neurobehavioral symptoms were therefore both common within the cohort, although their individual-level association was not assessed.

Conclusions: Children with nocturnal enuresis demonstrated a heterogeneous phenotype encompassing EEG maturational and organizational abnormalities alongside neurobehavioral difficulties. These findings support the relevance of neurodevelopmental mechanisms to the clinical heterogeneity of childhood enuresis and provide a rationale for prospective controlled studies integrating behavioral, sleep/arousal, and quantitative EEG assessments.