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Brain Dev. 2006 May;28(4):265-8. Epub 2006 Jan 10.
Hot water epilepsy occurring at temperature below the core temperature.
Auvin S, Lamblin MD, Pandit F, Bastos M, Derambure P, Vallee L.
Department of Pediatric Neurology, University Hospital, Lille, France. [email protected]
A 6-year-old girl had water reflex epilepsy occurring at lower temperature than the core temperature. Seizures
episodes consisted of a loss of consciousness absence followed by left predominant hypotonia with right frontotemporal high voltage slow waves on the ictal-EEG. Seizures were only observed when the water was poured on
scalp or face. Neuropsychological evaluation showed frontal dysfunction (Rey's figure). MRI study was normal.
Oxcarbazepine permitted the disappearance of seizures and an improvement of executive disorders. In this case,
the pathophysiological mechanism cannot be a hyperthermic related event. The temperature control as treatment
of hot-water epilepsy could be used after the exploration of its implication in seizure induction.
Indian Pediatr. 2004 Jul;41(7):731-3.
Hot water epilepsy - a report of three cases.
Incecik F, Herguner MO, Elkay M, Altunbasak S.
Department of Pediatric Neurology, Cukurova University Medical Faculty, Mustafa Kemal University Medical
Faculty, Balcali, Adana, Turkey.
Hot water epilepsy (HWE) is a rare form of reflex epilepsy caused by bathing with hot water. In this paper, we
describe three cases with hot water epilepsy.It occurs generally in children with normal psychomotor
development and children continue to develop normally after seizure. HWE has usually a favorable prognosis by
first avoiding lukewarm water and secondly using either intermittent oral prophylaxis with benzodiazepines or
conventional AEDs.
J Assoc Physicians India. 2003 Jan;51:43-4.
Prophylactic use of clobazam in hot water epilepsy.
Dhanaraj M, Jayavelu A.
Department of Neurology, Government Stanley Medical College and Hospital, Chennai-600 001.
OBJECTIVE: To assess the efficacy of intermittent administration of clobazam to prevent hot water epilepsy.
MATERIAL AND METHODS: Ten adults with 1:1 ratio of hot water epilepsy were administered 10 mg of
clobazam about one and half hour before each hot water head bath. They were followed up for nine months.
RESULTS: Nine out of 10 patients did not develop recurrence of seizure following regular hot water head bath
during nine month follow up period. One continued to get mild giddiness. The adverse effects observed were
sleepiness in two and fall in memory in one on the day of drug intake. CONCLUSION: Intermittent oral
administration of clobazam before hot water bath alone is effective in preventing hot water epilepsy with 1:1
Epilepsia. 2003;44 Suppl 1:29-32.
Hot-water epilepsy.
Satishchandra P.
Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India.
[email protected]
Geographically specific epilepsy syndromes are of epidemiologic interest and may assist in understanding the
pathogenic mechanism of epilepsy in general. Some may have a genetic basis with added environmental
influence. Among these epilepsy syndromes in India is an interesting type of reflex seizure known as hot-water
epilepsy (HWE) and single small computed tomography (CT)-enhancing lesions (SSCTLs).
Seizure. 2001 Oct;10(7):516-7.
Bathing epilepsy.
Seneviratne U.
Ratnapura General Hospital, Ratnapura, Sri Lanka. [email protected]
A patient who had complex partial seizures provoked by bathing is reported. All the attacks occurred during or
immediately after bathing, irrespective of water temperature. The semiology was suggestive of a seizure focus in
the mesial temporal lobe. Though there are some similarities with hot-water epilepsy, this case appears to be a
distinct type of reflex epilepsy. Copyright 2001 BEA Trading Ltd.
Hot water epilepsy: clinical and electrophysiologic findings based on 21 cases.
Bebek N, Gurses C, Gokyigit A, Baykan B, Ozkara C, Dervent A.
Department of Neurology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
PURPOSE: Our aim is to outline the clinical and electroencephalographic (EEG) features of patients with hot
water epilepsy (HWE), a rare and unique form of reflex epilepsy. METHODS: Twenty-one patients with HWE,
seen in our clinic until 1999, were studied. Male outnumbered female subjects in a ratio of 3:1. The age at the
onset of seizures ranged from 19 months to 27 years (mean age at onset, 12 years). RESULTS: The main factors
precipitating seizures were bathing with hot water and/or pouring water over the head. Six patients reported selfinduction, either by increasing the heat or the amount of water and/or recalling earlier bathing experiences. Nine
patients expressed feeling pleasure during the seizures. Twenty patients had partial seizures, eight of whom also
had secondarily generalized seizures. One patient had apparent generalized seizures only. Spontaneous seizures
were present in 62% of the cases. Interictal epileptogenic abnormalities were documented in the EEGs of eight
patients; the other eight had normal EEGs. The major sites of epileptogenic activity were over the unilateral
temporal regions (in 40% of patients). Neuroimaging studies available for 12 patients (four cranial computed
tomography and eight cranial magnetic resonance imaging scans) revealed normal findings. Seizure control in
patients who were followed up was achieved by reducing the temperature or the duration of the bath or shower;
several of the patients required medication. CONCLUSIONS: The major findings of this study are that HWE has
a male preponderance, can be self-induced, is often done for pleasure, has complex triggering factors, and shows
temporally located abnormalities in the EEGs. Although HWE is generally known to be self-limited, antiepileptic
drug treatment may sometimes be necessary to control seizures. Hot water epilepsy should be classified
separately among the epileptic syndromes.
J Child Neurol. 2000 Feb;15(2):125-8.
Hot water epilepsy: a benign and unrecognized form.
Ioos C, Fohlen M, Villeneuve N, Badinand-Hubert N, Jalin C, Cheliout-Heraut F, Pinard JM.
Department of Pediatric Neurology, Hopital Raymond Poincare, Garches, France. [email protected]
Hot water epilepsy is a reflex epilepsy. Seizures are provoked by hot water, and result from the association of
both cutaneous and heat stimuli. Described mainly in India and Japan, the condition seems to be rare in Europe,
where it occurs in young children. We report five infants aged from 6 months to 2 years. They had brief seizures
during bathing with activity arrest, hypotonia, and vasoactive modification; clonic movements were observed. A
simple treatment-decreasing the bath temperature-can be sufficient. Sometimes an antiepileptic drug is required.
Seizure course and psychomotor development are favorable. Hot water epilepsy is a benign form of epilepsy. Its
incidence could be underestimated because of confusion with febrile convulsions, vagal fits, or aquagenic
Eur Neurol. 1988;28(1):6-10.
Reflex-epilepsy induced by immersion in hot water. Case report and review of the literature.
Roos RA, van Dijk JG.
Department of Neurology, University Hospital Leiden, The Netherlands.
A patient with reflex epilepsy is described, in whom seizures were induced by bathing in hot water. The literature
is reviewed.