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  • Updated 07.14.2022
  • Released 01.03.2012
  • Expires For CME 07.14.2025

Hot water epilepsy

Introduction

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

According to the most recent position paper from ILAE, a reflex seizure is defined as a seizure that is consistently or nearly consistently elicited by a specific stimulus, which may be sensory, sensory-motor, or cognitive. The stimulus may be "elementary" (eg, light, touch), "complex" (eg, tooth-brushing, eating), or cognitive (eg, reading, calculating, thinking). Such a stimulus will have a high likelihood of eliciting a seizure, in contrast to a stimulus that may facilitate epileptiform abnormality (such as photoparoxysmal responses on EEG) or evoke a seizure, but not consistently (40; 26).

Hot water epilepsy is one of the reflex epilepsies induced by hot water pouring over the head, face, neck, or trunk during bathing (42). This type of reflex epilepsy was first reported from New Zealand in 1945 (02). 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 (13; 14). Satishchandra and colleagues reported a large clinical series of 279 patients with hot water epilepsy seen over a 4 year period (32). A prospective clinical series of 70 patients over a period of 2 years was added from the same center in 2012 (17). Another study reported 68 children with hot water epilepsy from another center in the same city (06). There have been several clinical series of hot water epilepsy reported from Turkey (19; 42).

Apart from classical hot water epilepsy, another type of reflex epilepsy triggered by hot water baths in infants has also been reported in literature (23). 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 (20).

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