REVIEW ARTICLE: Enuresis: Pathophysiology and treatment

Bedwetting is a common world-wide finding in school-age children (around 7% of 7-year-old children); it can be related to monosymptomatic nocturnal enuresis (MNE) in more than half of cases and to bladder dysfunction in the remainder. In most subjects, the diagnostic procedure is limited to patient and family history since physical examination is normal. The pathophysiology of MNE remains uncertain. It is likely that there are several kinds of MNE according to clinical features (polyuria? sleep disorders? response to desmopressin? psychopathological problems? primary/secondary trouble?) therefore leading to different therapeutic approaches. From a practical point of view, most patients respond well to either alarm system or desmopressin, which give significant results compared to placebo; tricyclic agents should be avoided because of their potential life-threatening adverse events. Further advances are expected in the pathophysiology and management of such a common disorder.     

Child neurology: past, present, and future: part 3: the future

This is the last of a 3-part series exploring the past, present, and future of the field of child neurology. This article addresses the 2 fundamental challenges facing child neurology. The most important challenge is our inadequate workforce; based on current numbers, recruitment patterns, and projected retirement, the child neurology clinical and research workforce shortage will likely worsen. The second challenge involves adapting our training to prepare child neurologists for changes ahead. We propose that these 2 issues are related, and that solutions need to include consideration of career options in research, education, and patient care.     

CNS drug development: part III: future directions

This column, the third in a series on central nervous system (CNS) drug development, discusses advances during the first decade of the 21st century and directions the field may take in the next 10 years. By identifying many possible new drug targets, the human genome project has created the potential to develop novel central nervous system (CNS) drugs with new mechanisms of action. At the same time, this proliferation of possible new targets has complicated the drug development process, since research has not yet provided guidance as to which targets may be most fruitful. This and other factors (eg, increasing regulatory requirements) have increased the cost and complexity of the drug development process. In addition, as more is learned about the biology of psychiatric illnesses, syndromes may be subdivided into more specific entities that are better understood from a pathophysiological and pathoetiological perspective. This is likely to lead to development of more targeted treatments focused on underlying causes of illness as well as prevention. The development of drugs for Alzheimer's disease is discussed as a possible model for future CNS drug development. We are at the beginning of an era when it is likely that the way in which CNS drugs are developed will need to be rethought, which will call for flexibility and creativity on the part of both drug developers and clinical researchers.