Hot water epilepsy with pachygyria

Abstract

Hot water epilepsy (HWE) refers to a specific type of reflex epilepsy precipitated by the stimulus of bathing in hot water. Pathogenesis is still unknown and temporal lobe has been thought to take part in the epileptogenesis. HWE can be symptomatic of focal cortical malformation, and few cases were reported. This is the third report of HEW in which a parietal malformation has been observed. Our hypothesis that sensory cortex might be implicated in the epileptogenic process is corroborated by two previous reports on patients with HWE and malformation of the parietal cortical development.

Reflex seizures triggered by cutaneous stimuli

“…Evidence supporting a non-specific location of focal onset, involving larger ictogenic areas can be observed in our patients, such as the presence of several seizure semiologies, history of diffuse brain injuries, including encephalitis, bilateral polymicrogyria and diffuse abnormal background activity on the EEG. These findings are in line with previous literature, that has described extensive lesions involving parietal or temporal lobes, combinations of different semiologies and sensibility to different water stimuli (e.g., bathing, mouth-washing, or touching) [8][9][10]. HWS and WCIS usually show poor response to medical treatment and stimulus avoidance has been considered the best treatment.…”

“…Reflex seizures are not typically the unique seizure type; rather they coexist with other types of seizures, such as those observed in our patients. Although it is difficult to assess, there seems to be a small predominance in males for this structural cases [7][8][9][10]. Evidence supporting a non-specific location of focal onset, involving larger ictogenic areas can be observed in our patients, such as the presence of several seizure semiologies, history of diffuse brain injuries, including encephalitis, bilateral polymicrogyria and diffuse abnormal background activity on the EEG.…”

“…Lesions related to HWS have been localized in the temporal and parietal lobes of both hemispheres. The cases of structural epilepsy with HWS occur at older ages than those in HWE and typically involve combined spontaneous non-reflex seizures in the same patient [8][9][10]. Previous literature suggests bathing with cold water as the first Purpose: Among the different precipitating stimuli for reflex seizures, Touch-Induced Seizures (TIS) and Hot Water Seizures (HWS) are consistently described in different reports.…”

Hot Water Epilepsy: Presentation of Three Cases

“…Hyperperfusion areas have been reported via single photonemission computed tomography in certain cases of HWE (10). Patients with HWE who have focal epileptic activity originating from the temporal or parietal lobes on EEG, temporal hippocampal sclerosis, dysplasia, cystic changes, and other abnormal findings such as cavum septopellucidum and pachygyria on MRI have also been reported (4,11,12,13). The MRI and EEG results in our patients were normal.…”

The Pivotal Role of the Parieto-Occipital Lobe in Card Game-Induced Reflex Epilepsy: A Voxel-Based Morphometry Study

“…The parietal lobe is thought to be a source of other reflex epilepsy. The sensory cortex might play a role in triggering seizures evoked by hot water [24] , and neuro-radiologic investigations have indicated the existence of cortical abnormalities of the parietal lobe in rub epilepsy as, well as tooth brushing-induced epilepsy [25,26] . Moreover, studies regarding thinking-induced epilepsy have revealed that neuropsychological tests pointed to parietal cortical dysfunction, and it sensitive to parietal dysfunction such as Koh's block design test was most effective in eliciting EEG abnormality [27] .…”