Ictal Video-Electroencephalography Findings in Bathing Seizures: Two New Cases and Review of the Literature

Abstract

Introduction: Reflex bathing seizures are described during the course of bathing in water near body temperature. These seizures differ from other epilepsies characterized by bathing-induced seizures such as hot water epilepsy, but there are few well-described patients and only some of these have been documented by ictal video-electroencephalography.

Methods: Our objective was to characterize the clinical presentation of bathing-induced seizures demonstrated by ictal video-electroencephalographic recordings with water temperature below 38°C. We described two previously unreported infants and reviewed additional cases in the literature that fulfilled those criteria.

Results: Eighteen infants were indentified. They were predominantly male (72%), and the mean age of seizure onset was 15 months (one to 36 months). The most frequent seizure triggers included pouring water over the face and immersion. Seizures were of focal onset with loss of awareness and prominent autonomic symptoms. Ictal video-electroencephalography revealed delta-theta high-amplitude focal waves involving temporal and adjacent regions, with a rapid spread to the ipsilateral hemisphere or generalization. Avoiding known triggers usually controlled the seizures, but carbamazepine, valproate, and levetiracetam were also helpful. Neuroimaging was normal in all cases, and neurodevelopment was unaffected.

Discussion: Bathing seizures predominate in boys with an early onset and a benign self-limited course. The use of ictal video-electroencephalographic recordings in these cases leads to diagnosis and reveals individual differences in triggers.

Keywords: Bath-induced seizures; Bathing seizures; Hot water epilepsy; Ictal EEG; Reflex epilepsy; Reflex seizures.