Logan BL, Blais S. Giggle incontinence: Evolution of concept
and treatment. J Pediatr Urol. 2017 Oct;13(5):430-435.
Abstract
BACKGROUND:
Giggle incontinence is a sudden and involuntary episode of
urinary incontinence that is provoked by an episode of laughter. Decades of
case studies and small research studies have formed the basis of what is known
about giggle incontinence; however, much remains unknown about this type of
incontinence, leaving the recommendations for clinical management somewhat
unguided.
METHODS:
A systematic review of 22 articles on the topic of
"giggle incontinence" and related terms was conducted, including all
published articles and commentaries since the term was first seen in print in
1959.
RESULTS:
This review provides a historical context for the diagnosis,
a summary of what is known about its etiology, and a summary of current treatments.
CONCLUSIONS:
There is disagreement about the pathophysiology of laughter
incontinence, with two differing explanations. The first emphasizes the
neurologic origin of the cascade of events during laughter and urination, and
draws a likeness to cataplexy and other CNS disorders, and emphasizes treatment
with methylphenidate. The second emphasizes urologic dysfunction, with
biofeedback and bladder retraining as the recommended therapy. Comprehensive
treatment of children with laughter incontinence requires an appreciation of
both concepts. Since inception of the concept there has been question about the
appropriateness of the term "giggle incontinence." This review
encourages discussion among readers/clinicians about the term and the essential
qualities of the diagnosis.
Telli O, Hamidi N, Kayis A, Suer E, Soygur T, Burgu B. Can
the success of structured therapy for giggle incontinence be predicted? Int
Braz J Urol. 2016 Mar-Apr;42(2):334-8.
Abstract
INTRODUCTION:
To evaluate possible factors that can guide the clinician to
predict potential cases refractoriness to medical treatment for giggle
incontinence (GI) and to examine the effectiveness of different treatment
modalities.
MATERIAL AND METHODS:
The data of 48 children referred to pediatric urology
outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean
age, follow-up, GI frequency, associated symptoms, medical and family history
were noted. Incontinence frequency differed between several per day to less
than once weekly. Children were evaluated with uroflowmetry-electromyography
and post-void residual urine. Clinical success was characterized as a full or
partial response, or nonresponse as defined by the International Children's
Continence Society. Univariate analysis was used to find potential factors
including age, sex, familial history, GI frequency, treatment modality and
dysfunctional voiding to predict children who would possibly not respond to
treatment.
RESULTS:
Mean age of the patients was 8.4 years (range 5 to 16). Mean
follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4
years and 14.2±2.3 months respectively. While 12 patients were treated with
only behavioral urotherapy (Group-1), 11 patients were treated with
alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients
with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence
was refractory to eight children in-group 1; six children in-group 2 and eight
children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on
uroflowmetry-EMG were found as outstanding predictive factors for resistance to
treatment modalities.
CONCLUSIONS:
A variety of therapies for GI have more than 50% failure
rate and a standard treatment for GI has not been established. The use of
medications to treat these patients would not be recommended, as they appear to
add no benefit to symptoms and may introduce severe adverse effects.
Chang JH, Lee KY, Kim TB, Yoon SJ, Lee T, Kim KH. Clinical
and urodynamic effect of methylphenidate for the treatment of giggle
incontinence (enuresis risoria). Neurourol Urodyn. 2011 Sep;30(7):1338-42.
Abstract
AIMS:
We retrospectively investigated the efficacy of
methylphenidate (MPH) in giggle incontinence (GI), and the relationship between
GI and urodynamic parameters.
METHODS:
Nine (n = 9) female GI patients underwent 1 year of
treatment with 5 mg MPH. Three questionnaires, voiding diaries, and UDS were
conducted before and after treatment. The severity of GI was classified into
mild, moderate, and severe. Clinical success was characterized as: full
response, response, partial response, and non-response.
RESULTS:
The mean age of all patients was 16.2 ± 2.3 years. Five
patients had mild, one had moderate, and three had severe grade incontinent.
All patients reported complete cessation of wetting after MPH treatment. The
mean duration of asymptomatic period was 7 ± 3.2 months. There were no
statistically significant score changes in all three questionnaires: Urgency
Perception Scale (UPS), Overactive Bladder Symptom Score (OABSS) and Primary
Overactive Symptom Questionnaire (POSQ), and voiding diaries (P > 0.05). In
UDS, there were no statistically significant altered parameters, except maximum
urethral closure pressure (MUCP) and maximum urethral pressure (MUP). After
treatment, the mean MUCP was increased from 52.2 ± 6.8 to 73.0 ± 5.4 cmH(2) O
(P < 0.05), and the mean MUP was increased from 48.6 ± 7.3 to 70.2 ± 5.0
cmH(2) O (P < 0.05).
CONCLUSIONS:
MPH can be a viable option for the primary treatment of GI,
and it may be related to increasing urethral closure pressure. It was not
possible to establish if a relationship between GI and detrusor overactivity
exists.
Sher PK, Reinberg Y. Successful treatment of giggle
incontinence with methylphenidate. J Urol. 1996 Aug;156(2 Pt 2):656-8.
Abstract
PURPOSE:
Giggle incontinence, the second most common type of childhood
enuresis unrelated to disease, is notoriously difficult to treat. However, the
association of laughter or emotion precipitated alteration of muscle tone is
suggestive of a functional relationship to cataplexy, a part of the narcoleptic
syndrome complex that may respond to stimulant medication.
MATERIALS AND METHODS:
Two boys and 5 girls (mean age 10.9 years) with giggle
incontinence, a positive family history of giggle incontinence (4 patients) and
no evidence of urological disease were treated with methylphenidate for 1 to 5
years.
RESULTS:
All patients responded positively with complete cessation of
enuresis to varying dose schedules of methylphenidate.
CONCLUSIONS:
These results suggest that giggle incontinence is a
centrally mediated and likely hereditary disorder that may share a common
pathophysiological basis with the narcolepsy/cataplexy syndrome.
Sher PK. Successful treatment of giggle incontinence with
methylphenidate. Pediatr Neurol. 1994 Feb;10(1):81. (no abstract)
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