Neuromodulation

Neuromodulation can be administered as mono-therapy or additional therapy in children who prefer this treatment, children who refuse medication, and children in whom anti-muscarinics are insufficient or have to be stopped because of side effects.

The treatment options include parasacral transcutaneous electrical nerve stimulation (parasacral TENS), percutaneous tibial nerve stimulation / Stoller afferent neurostimulation (PTNS/SANS), and implanted sacral nerve stimulation (implanted SNS).

The most commonly used therapy is home-based TENS with transcutaneous electrodes. The neuromodulation technique is based on the principle that electrical current directly affects the central nervous system by artificially activating neural structures, facilitating both neural plasticity and normative afferent and efferent activity of the lower urinary tract.

Several studies suggest that neuromodulation is safe and useful for inhibiting detrusor contractions although some controlled studies showed contrasting results, one with only a very high placebo effect based on the attention given to the child’s problem, one with convincing differences between groups.