Hot water epilepsy

K P Vinayan MD (Dr. Vinayan of the Amrita Institute of Medical Sciences has no relevant financial relationships to disclose.)
Solomon L Moshé MD (Dr. Moshe of Albert Einstein College of Medicine received honorariums from UCB as a member of a data and safety monitoring board.)
Jerome Engel Jr MD PhD, editor. (Dr. Engel of the David Geffen School of Medicine at the University of California, Los Angeles, has no relevant financial relationships to disclose.)
Originally released January 3, 2012; last updated September 12, 2016; expires September 12, 2019

This article includes discussion of hot water epilepsy, warm water epilepsy, bathing epilepsy, and water immersion epilepsy. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Hot water epilepsy is one of the reflex epilepsies induced by hot water being poured over the head, face, neck, or trunk during bathing. Two types of hot water epilepsies exist: the classical one seen in older children and adults, which is usually triggered by head baths, and a variant seen in infants precipitated by immersion of the lower trunk in hot water. In this article, the authors review the clinical, pathophysiological, and epidemiologic data related to hot water epilepsies. Relevant management strategies are also discussed. Even though initially considered as a geographically restricted epilepsy syndrome, hot water epilepsy is increasingly being reported all around the world. Hot water epilepsy in infancy may have an association with febrile seizures and Dravet syndrome. Management strategies include avoidance of hot water baths, antiepileptic drugs, and psychobehavioral approaches.

Key points

 

• Hot water epilepsy is one of the reflex epilepsies induced by hot water pouring over the head, face, neck, or trunk during bathing.

 

• Two types of hot water epilepsies exist; a classical one seen in older children and adults usually triggered by head baths, and a variant seen in infants precipitated by immersion of the lower trunk in hot water.

 

• The exact pathogenesis is unclear.

 

• Avoidance of hot water bath is currently considered to be the best preventive strategy

 

• The majority of patients have a good outcome.

Historical note and terminology

Reflex epilepsies are classified as a group of etiologically heterogeneous epileptic entities, the common factor being precipitation of seizures by precise sensory and cognitive precipitating factors. The seizures may occur immediately with stimuli or after a short delay. However, this response should be consistent. Photosensitive epilepsies are so far the commonest in this group. However, seizures precipitated by touch, music, reading, eating, and other complex cognitive processes have also been reported (Wolf 2004).

Hot water epilepsy is one of the reflex epilepsies induced by hot water pouring over the head, face, neck, or trunk during bathing (Zeki et al 2010). This type of reflex epilepsy was first reported from New Zealand in 1945 (Allen 1945). Even though cases have been subsequently reported from different countries around the world and across all races, there was a clustering of cases from South India (Mani et al 1968; Mani et al 1974). Satishchandra and colleagues reported a large clinical series of 279 patients with hot water epilepsy seen over a 4 year period (Satishchandra et al 1988). A prospective clinical series of 70 patients over a period of 2 years was added from the same center in 2012 (Meghana et al 2012a). There have been several clinical series of hot water epilepsy reported from Turkey (Milanlioglu et al 2010; Zeki et al 2010).

Apart from classical hot water epilepsy, another type of reflex epilepsy triggered by hot water baths in infants has also been reported in literature (Plouin and Vigevano 2004). This condition is also called bathing epilepsy or water immersion epilepsy, as the temperature of the water has not always been hot and the trigger includes immersion of only the lower part of the body in hot water, as in the Japanese style bath (Nechay and Stephenson 2009).

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