"Hot-water epilepsy ", "warm-water epilepsy", or bathing epilepsy? Report of three cases and considerations regarding an old theme

Abstract

.ABSTRACT -Partial and generalized tonic-clonic reflex seizures related to hot water bathing have been described as temperature-related. We describe three cases of bathing epilepsy: a 28 year-old white male and a 30 year-old white female with spells triggered either by warm or hot water, and a 32 year-old female with spells triggered by hot water. The later two of the three cases presented localized epilepsy and a familial history of epilepsy. A complex tactile stimuli might play the most relevant role on seizure triggering, as well as water temperature with an additive effect over cutaneous stimulation.KEY WORDS: epilepsy, epilepsy-generalized, epilepsy-localized, seizures-reflex, hot-water epilepsy.Epilepsia do banho quente, do banho morno, ou apenas do banho? Relato de três casos e considerações sobre um velho tema RESUMO -Crises reflexas a banhos quentes, tônicas-clônicas parciais e generalizadas foram descritas como relacionadas à temperatura. Descrevemos três casos de epilepsia do banho quente: um homem de 28 anos e uma mulher de 30 anos com crises provocadas por contato com água morna ou quente e uma mulher de 32 anos com crises ao contato com água quente. Os últimos dois casos apresentaram epilepsia localizada e um histórico familiar de epilepsia. Nesta forma de epilepsia, um estímulo táctil complexo parece ter o p a p e l mais relevante na precipitação das crises, sendo potencializado pela temperatura da água. PALAVRAS-CHAVE: epilepsia, epilepsia generalizada, epilepsia localizada, crises reflexas, epilepsia do banho quente.Hot water epilepsy has been previously studied and re p o rted, occurring mainly in India 1 , 2 , 3 . Both partial and generalized tonic-clonic seizures related to hot water bathing have been described as tempera t u re -related, often triggered by temperatures ranging from 40 to 50 o C 1 -3 . As in many other types of re f l e x s e i z u res, the same stimulus (hot water) triggers either generalized tonic-clonic or partial seizures, suggesting that generalized and localized epilepsies might be influenced by the same aff e rent pathways.We describe three cases of bathing epilepsy, one t r i g g e red by hot water, and the other two either by w a rm or hot water. The pathophysiological significance of seizure triggering by warm water and the proper denomination of this syndrome is discussed. CASESCase 1 -A 28 year-old white male started having seiz u res at the age of 7. Seizures would start with dizziness, followed by left hemiclonic seizures starting on his left arm . He had had birth anoxia, and his brother also had epileps y. Seizures were initially controlled with phenobarbital, but re c u rred at the age of 14, when partial seizures characterized by bilateral headache, cephalic paresthesia, and a negative motor phenomenon on his left upper limb w e re triggered either by warm (but not cold) or hot water. Symptoms lasted about 5 minutes. The CT was normal, but an interictal EEG showed a right rolandic focus and an independent left temporal spiking. Carbamazepine 1200mg/day...

Hot water epilepsy: A rare form of reflex epilepsy

“…[14] Kowcas et al reframed the term as bathing epilepsy rather than hot water epilepsy because their patients had seizures with warm water but not with hot water. [15] Nechay et al postulated altered autonomic regulations or some form of channelopathies as the underlying mechanisms for this disorder. [16] Satishchandra related this disorder as a form of geographically specifi c epilepsy syndrome, where some cases might have genetic basis with added environmental infl uence.…”

“…Antiepileptic drugs are only indicated when such patients continue to have seizures even during regular baths with normal water temperature or non-refl ex seizures. [15] Since seizures show a tendency to decrease spontaneously, withdrawal of medication, if it had been given, should be carefully undertaken only aft er several months. The above two case descriptions were made to highlight the rarity of its occurrence and to emphasize that HWE could be controlled exclusively by lifestyle modifi cation without resorting to anti-epileptic medication.…”

Hot water epilepsy: Is it an autosomal dominant inherited disorder?

“…[3] Yeni Zelanda, Avustralya, Japonya, Kanada, İngiltere ve Amerika Birleşik Devletleri'nden izole olgu bildirimleri olmuştur. [4][5][6][7] SSE ile ilgili en geniş seriler Hindistan'dan bildirilmiştir. [7] Satishchandra ve ark.…”

EEG source estimation in a rare patient with cold‐induced reflex epilepsy

“…Temperature-related reflex epilepsy mostly takes the form of hot water epilepsy (Bebek et al, 2001;Zeki et al, 2010;Meghana et al, 2012). This type of epilepsy is often triggered by contact with, or immersion in hot water, usually with a temperature greater than 37 degrees, and manifests with generalized tonic-clonic or complex partial seizures (Szymonowicz and Meloff, 1978;Satishchandra et al, 1988; Y. Ren, et al Kowacs et al, 2005). However, there are few reports and studies on reflex epilepsy associated with low or cold temperatures.…”