Hot water epilepsy: seizure type, water temperature, EEG findings and treatment

Abstract

Objectives: Hot water epilepsy (HWE) or bathing epilepsy is one of the reflex epilepsies induced by hot water pouring over the head, face, neck, or trunk during bathing. The aim of this study was to demonstrate the clinical and electroencephalographic features and the management alternatives of the patients with HWE.

Methods: The age of seizure onset, duration of seizure, family history, interictal and postictal electroencephalography findings, triggering temperature of water, type of seizure, medication, and follow-up results were evaluated for each patient.

Results: The mean age at seizure onset was 10.5 years. The mean duration of seizures was 10 years. Interictal EEG recordings showed focal abnormalities in 4 patients and generalized abnormalities in 3 patients. Only one patient had normal interictal EEG findings. Among the 8 patients with HWE, 6 had seizures only during hot bathing, whereas 2 had additional seizures. Seven patients had generalized tonic-clonic seizures and 1 patient had complex partial seizure during their hot bathings. The mean triggering temperature of water was calculated as 41.4 degrees C. The mean duration of follow-up period was 23 months. Five patients became seizure-free during the follow-up period and seizures persisted in 3 patients. Antiepileptic drugs were given (800 mg/d carbamazepine for 2 patients and 600 mg/d phenytoin for 1 patient) to these 3 patients and they also became seizure-free during the follow-up period.

Conclusions: Hot water epilepsy is a benign reflex epilepsy. Lowering water temperature must be the first step for the treatment. If needed, antiepileptic drugs should be considered as an additive treatment.