***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The lack of circadian rhythmicity of plasma arginine vasopressin ( AVP ) in primary nocturnal enuresis ( PNE ) in some children is known . The original test protocol is time-consuming and needs excellent compliance by children and parents . The goals of the presented study are the introduction of a simple screening test and the evaluation of the response of treatment using intranasal synthetic vasopressin .  Fifty-five children ( aged 8.2 + /- 3.1 years ) with PNE and 15 children ( aged 7.9 + /- 2.4 years ) of a control group were investigated . Using a st and ardized protocol , AVP levels were measured by radioimmunoassay ( RIA ) under controlled water intake 3 times per day over a period of 72 h. Fourteen of 55 tested children ( 25.5 % ) with PNE had a significant decrease in nocturnal AVP when compared to the control group . We measured also an increased nocturnal urine volume and a lower urine osmolality in this enuretic group . Eight of 14 patients ( 57.1 % ) with plasma AVP deficiency ( AVPD ) also had bladder instability . Nine of 14 patients ( 64.3 % ) with AVPD with or without concomitant bladder instability were totally dry during desmopressin treatment , but only 2 ( 14.3 % ) remained dry after discontinuation of treatment . Our data suggest that nocturnal urine osmolality measurement may reflect AVPD and predict a positive treatment outcome The effect of 20 micrograms . desaminocysteine-D-arginine vasopressin intranasally on childhood nocturnal enuresis was studied in a r and omized double-blind cross-over series of 54 children . The wetting was significantly less frequent during the 2 , 3-week periods on desaminocysteine-D-arginine vasopressin than during placebo periods , or during periods without any treatment . The effect of desaminocysteine-D-arginine vasopressin was reproducible and the efficacy of desaminocysteine-D-arginine vasopressin depended on the frequency of wetting before treatment . After discontinuation of the short treatment enuresis recurred immediately . No side effects were noted . We conclude that desaminocysteine-D-arginine vasopressin may well be used in the management of childhood enuresis , especially in situations when an immediate effect is desirable Fifty children with primary nocturnal enuresis were r and omised for a study comparing desmopressin ( DDAVP ) and enuresis alarm .  Forty six completed the trial , 24 of whom were treated with 20 micrograms intranasal desmopressin nightly and 22 with enuresis alarm for three months . Failures were crossed over and relapses were continued on the same treatment for a further three months . The improvement rate was 70 % in the group given desmopressin and 86 % in the group treated with alarm ; the difference was not significant . During the first week of treatment the group given desmopressin was significantly dryer , and at the end of the study 10 of these patients relapsed compared with one patient in the group given the alarm .  No serious side effects were observed . This study confirms the role of conditioning treatment as preferable in long term treatment of nocturnal enuresis . When this fails or when a safe drug with rapid effect is needed , however , desmopressin is a useful alternative OBJECTIVES To assess whether the synthetic vasopressin analogue desmopressin [ 1-desamino 8-D-arginine vasopressin ] is efficacious and safe in the management of nocturia + /- enuresis in patients with multiple sclerosis . PATIENTS AND METHODS Twenty-two women and 11 men , under 65 years of age , with clinical ly definite multiple sclerosis and nocturnal frequency + /- enuresis were entered into the study . A two week placebo run-in , to establish normal voiding patterns , followed by a double-blind , placebo-controlled , cross-over study of 20 micrograms intranasal desmopressin at night-time was carried out . RESULTS Desmopressin caused a significant decrease in nocturnal urinary frequency , nocturnal urinary volume and the percentage of total daily urine passed at night . There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia . CONCLUSION Desmopressin is an efficacious and safe treatment for nocturia + /- enuresis in patients with multiple sclerosis The response of desamino-D-arginine vasopressin ( DDAVP ) was investigated in 32 enuretic children in a double-blind clinical study . The 15 children treated with DDAVP showed a significant reduction in the incidence of bed wetting -- from 18.7 + /- 6.5 to 6.5 + /- 9.2 wet nights per 30 days . In 6 children bed wetting stopped entirely , in 6 there was a satisfactory response , and in 3 the response was marginal or there was none . When DDAVP was stopped most children reverted to their earlier bedwetting habits ( 15.7 + /- 8.9 nights a month ) . Response to DDAVP was significantly better in children aged more than 10 years ( mean age for the entire group ) . The administration of DDAVP was not associated with any appreciable change in morning urine osmolalities . No adverse effects were noted . It is concluded that DDAVP is effective in nocturnal enuresis , particularly in older children . It is suggested that the cessation of bed wetting may , in part , reflect functional properties of DDAVP rather than antidiuresis To characterize the children with enuresis likely to respond to desmopressin acetate  , we performed a double-blind crossover study that included the use of a placebo . During the two weeks of desmopressin administration , six children ( 12 % ) had 13 or 14 dry nights , and 15 children ( 29 % ) had eight to 12 dry nights . Among the 17 children aged 9 years or older , with four to seven dry nights during the two-week baseline period , 12 children ( 71 % ) responded to desmopressin ( eight to 14 dry nights ) . In contrast , none of the 15 children younger than 9 years of age with fewer than three dry nights before therapy responded . During the posttreatment period , only four of the 21 drug responders reported a persistent effect .  Desmopressin may be effective in reducing the frequency of enuresis , especially in children older than 9 years of age without nightly enuresis During the period from March to September 1989 , 40 children suffering from primary nocturnal enuresis , aged between 5 and 14 years , were included in a study to assess the comparative therapeutical efficacy of DDAVP and acupuncture . Children were divided into four groups of 10 : group A was treated with DDAVP , group B was treated with acupuncture , group C was treated with DDAVP and acupuncture and group D was treated with placebo ( control ) . The trial design included 3 periods : observation ( 2 weeks ) , treatment ( 8 weeks ) and follow-up ( 4 weeks ) . Nineteen children completed the study . The efficacy of treatment , which was expressed as a percentage of dry nights , was high in both the DDAVP and acupuncture groups , when used separately . The combined treatment of DDAVP and acupuncture appeared to be the most efficacious both in terms of the percentage of dry nights at the end of treatment and in relation to the stability of results , even after the end of the study . The paper gives a detailed analysis of correlations between type of treatment and urinary osmolarity OBJECTIVE The aim of the study was to compare the efficacy and safety of different doses of DDAVP spray treatment ( 20 to 40 mcg/day ) in patients with primary monosymptomatic nocturnal enuresis ( defined as three or more wet nights per week ) . MATERIAL AND METHODS 237 patients ( 152 males , 75 females ; age range 5 - 17 years ) , with no infections or organic abnormalities of the urinary apparatus and no neurological disorders , were admitted into the trial . The experimental design was planned as an " open study " with five different treatments schedules ( 5 groups ) . The daily doses of DDAVP at bedtime in groups 1 and 2 were 20 and 30 mcg , respectively , for 6 weeks . In groups 3 and 4 the daily doses for the first 2 weeks were 20 and 30 mcg , respectively , and then , after a washout period of 2 weeks , the daily doses for the two groups were 30 and 20 mcg , respectively . A dose-response study ( 20 to 40 mcg/day ) was carried out in group 5 . RESULTS DDAVP spray therapy in primary monosymptomatic nocturnal enuresis was found to be resolutive in 70 - 75 % of treated patients . No difference in response was found between the patients treated with the daily dose of 20 and those on 30 mcg . No important reactions were observed in patients treated with DDAVP spray at the different daily dose ( 20 to 40 mcg ) or for different periods of time ( up to 6 weeks ) . CONCLUSIONS DDAVP spray therapy at a dose of 20 mcg/day was effective in 70 - 75 % of primary monosymptomatic nocturnal enuretics . In non-responders the daily dose of DDAVP should be increased to 30 to 40 mcg The effect of desamino-D-arginine vasopressin was investigated in a double-blind study of 37 children more than 9 years old with nocturnal enuresis resistant to conventional therapy . A significant reduction of wet nights was observed but as soon as the medication was stopped the children reverted to earlier bedwetting habits PURPOSE Desmopressin nasal spray has proved to be efficacious treatment of primary nocturnal enuresis . Oral desmopressin tablets would be a more easily used , convenient vehicle for our patients and their parents . We evaluated the effectiveness of oral desmopressin in decreasing the number of wet nights in patients with primary nocturnal enuresis . MATERIAL S AND METHODS We performed a double-blind , placebo controlled , parallel group trial of oral desmopressin in 141 children 5 to 17 years old with documented primary nocturnal enuresis at 14 sites . Patients were screened for number of wet nights for 2 weeks before study entry . A minimum of 3 wet nights weekly for 2 consecutive weeks was required for study entry . Patients were r and omized to receive 200 , 400 or 600 mcg . desmopressin or placebo before bedtime . Fluids were restricted 2 hours before bedtime based on body weight . The primary efficacy variable was mean decrease in the number of wet nights recorded during the last 2-week treatment period . The percentage of responding patients and mean decrease from baseline in number of wet nights at 2 , 4 and 6 weeks were also assessed . RESULTS The decrease in wet nights was 9 , 20 , 30 and 36 % for placebo , and 200 , 400 , and 600 mcg . desmopressin orally per day , respectively . The 600 mcg . dose of oral desmopressin daily was statistically significantly different ( p < 0.05 ) from placebo in decreasing wet nights . A complete or near complete response ( 0 to 2 wet nights ) was noted in 3 , 18 , 33 and 24 % of the patients who received placebo , and 200 , 400 and 600 mcg . oral desmopressin daily , respectively . The 400 and 600 mcg . treatment groups were statistically significantly different ( p < 0.05 ) from placebo . A less than 50 % decrease in wet nights was noted in 83 , 79 , 64 and 61 % of the patients who received placebo , and 200 , 400 and 600 mcg . oral desmopressin daily , respectively . Oral desmopressin exhibited a dose response in the treatment of primary nocturnal enuresis . The linear trend for the decrease in wet nights was statistically significant ( p < 0.05 ) . CONCLUSIONS A dose of 600 mcg . oral desmopressin daily significantly decreased the mean number of wet nights when administered for 6 weeks . A higher dose may be necessary for an improved response PURPOSE The use of desmopressin in patients with primary nocturnal enuresis is based on the hypothesis of a nocturnal lack of endogenous arginine vasopressin . However , in addition to the kidney , other targets of desmopressin are known . Therefore , we examined whether the administration of desmopressin influences central nervous function in children with primary nocturnal enuresis . MATERIAL S AND METHODS Our prospect i ve , r and omized , double-blind , placebo controlled cross-over study was performed on 40 children with nocturnal enuresis . Patients were r and omly assigned to receive either 20 microg . desmopressin intranasally or 0.9 % saline solution . Each group comprised 19 and 21 to children , respectively . After 2 weeks the groups were switched . The children were tested for short-term memory and reaction time to both treatments . Statistical analysis was done using the Wilcoxon matched pairs test . RESULTS Median patient age was 8.0 years ( range 6 to 13 ) . During desmopressin treatment children in both groups had a significant decrease of wet nights ( 5. 
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Amitriptyline ( another tricyclic ) was not consistently better than desmopressin either alone or when used as a supplement .
Combining alarm and drug therapy was found to be superior to alarm treatment alone .
REVIEW ER 'S CONCLUSIONS Desmopressin rapidly reduced the number of wet nights per week , but there was some evidence that this was not sustained after treatment stopped .
Comparison with alternative treatments suggested that desmopressin and tricyclics had similar clinical effects , but that alarms produced more sustained benefits .
However , the risk of water intoxication associated with over-drinking before bedtime has been reported .