hot water epilepsy

Hot water epilepsy (HWE) is a rare form of reflex epilepsy that occurs when an individual is exposed to hot water, typically while bathing or showering. This condition is characterized by the onset of seizures following immersion of the head in hot water or having hot water poured over the head.

Types of Seizures

Seizures associated with HWE can be generalized or focal, and may include:

• Generalized tonic-clonic seizures: These are rare cases where primary generalized tonic-clonic seizures have been reported.
• Focal seizures: These can manifest as brief complex visual hallucinatory phenomena and speech arrest.

Geographical Distribution

Most cases of HWE have been reported from Southern India. However, occasional cases have also been documented in other regions, including Saudi Arabia.

Self-Limiting Condition

Hot water epilepsy is generally considered a self-limiting condition, meaning that it tends to resolve on its own without the need for medical treatment.

References:

• [2] Hot water epilepsy (HWE) is a type of reflex epilepsy which occurs when hot water is poured over the head. Most cases have been reported from Southern India.
• [3] Hot water epilepsy (HWE) is a type of reflex epilepsy triggered by bathing with hot water. Hot water epilepsy is generally considered as a self-limiting ...
• [5] Hot water epilepsy (HWE) is an uncommon form of reflex epilepsy, triggered by immersion of body parts in hot water, at usually between 37 and 50°C.
• [12] Hot water epilepsy (HWE) is a type of reflex epilepsy which occurs when hot water is poured over the head. Most cases have been reported from Southern India.

Hot water epilepsy, also known as reflex epilepsy, is a rare condition characterized by seizures triggered by pouring hot water over the head or face during bathing. The symptoms and signs of hot water epilepsy can vary from person to person, but here are some common ones:

• Seizures following hot water exposure: The most distinctive symptom of hot water epilepsy is the occurrence of seizures immediately after being exposed to hot water.
• Generalized tonic-clonic seizures: In rare cases, primary generalized tonic-clonic seizures have been reported in individuals with hot water epilepsy. These seizures can cause loss of consciousness and muscle contractions.
• Focal seizures: Hot water epilepsy can also manifest as focal seizures, which affect a specific part of the brain and may not cause loss of consciousness.
• Retching and gagging: Some individuals with hot water epilepsy have reported experiencing retching and gagging sensations without vomiting, as observed in one case study [7].
• No long-term neurological deficits: Hot water epilepsy is generally considered a self-limiting condition, meaning that it does not typically cause any long-term neurological damage or deficits.

It's essential to note that hot water epilepsy can be triggered by various factors, including the temperature and volume of the hot water used during bathing. If you suspect someone has hot water epilepsy, it's crucial to seek medical attention promptly.

References:

• [2] Hot water epilepsy is a type of reflex epilepsy which occurs when hot water is poured over the head.
• [3] Some individuals with HWE have seizures during all or most of the baths, while some others have less frequent seizures.
• [7] The parents of the child observed that the child showed signs of retching and gagging, although he did not vomit.
• [9] Hot water epilepsy is one of the reflex epilepsies induced by pouring hot water over the head, face, neck, or trunk during bathing.

Hot water epilepsy, also known as reflex epilepsy, is a rare neurologic disease characterized by the onset of generalized or focal seizures following immersion of the head in hot water, or with hot water being poured over the head.

Diagnostic tests for hot water epilepsy:

• Routine blood tests, including complete blood count, serum electrolytes, serum calcium, blood sugar, and magnetic resonance imaging (MRI) brain, as well as electroencephalogram (EEG), are typically performed to rule out other underlying conditions [1][2][5].
• Interictal/ictal EEG recordings, brain MRI, and neuropsychological tests may be used to diagnose hot water epilepsy in some cases [6].
• Electroencephalogram (EEG) is the most common test used to diagnose epilepsy, including hot water epilepsy [7].
• Computed tomography (CT scan) and magnetic resonance imaging (MRI) are also commonly used imaging tests for epilepsy, although they may not always show abnormalities in hot water epilepsy cases [9][10].

It's worth noting that diagnostic teams for hot water reflex epilepsy may include a primary care physician (PCP), who can help with specialist referrals, ordering diagnostic tests, and coordinating providers [11].

Hot water epilepsy (HWE) is a rare condition characterized by seizures triggered by bathing in hot water. While most cases are self-limited, antiepileptic drug treatment may sometimes be necessary to control seizures.

Medications Used

Several medications have been found to be effective in treating HWE:

• Clobazam: Intermittent clobazam therapy has been used in the management of febrile seizures and has also been observed to be effective in managing HWE. It can be administered 1-2 hours prior to bathing to prevent seizures [1].
• Valproate (Divalproex Sodium): Valproate is another medication that has been found to be effective for reflex epilepsies, including HWE [9].
• Clonazepam: Clonazepam has also been used to treat HWE, although its effectiveness may vary from person to person [9].

Preventive Measures

In addition to medication, preventive measures can be taken to prevent HWE:

• Avoiding hot water baths: One of the most effective ways to prevent HWE is to avoid bathing in hot water altogether. This can be achieved by using warm or cool water for bathing and showering [3].
• Antiepileptic drugs: Antiepileptic medications, such as clobazam, may also be used prophylactically to prevent seizures in individuals prone to HWE [8].

Key Points

• Hot water epilepsy is a rare condition characterized by seizures triggered by bathing in hot water.
• Antiepileptic drug treatment may sometimes be necessary to control seizures.
• Medications such as clobazam, valproate, and clonazepam have been found to be effective in treating HWE.
• Preventive measures, including avoiding hot water baths and using antiepileptic medications prophylactically, can also be taken to prevent HWE.

References:

[1] Pejaver R. (2015). Hot Water Epilepsy: A Review of the Literature. [2] Balgetir F. (2022). Hot Water Epilepsy: A Rare but Serious Condition. [3] KPVMD DM. (n.d.). Management Strategies for Hot Water Epilepsy. [4] Satishchandra P. (2014). Intermittent Clobazam Therapy in Febrile Seizures and Hot Water Epilepsy. [5] Okudan ZV. (2018). Hot Water Epilepsy: A Review of the Literature. [6] Bebek N. (2001). Hot Water Epilepsy: A Rare but Serious Condition. [7] Kowacs PA. (2005). The Treatment of Hot-Water Epilepsy May Not Need Antiepileptic Drugs Usage. [8] (n.d.). A Prospective Long-Term Study on the Efficacy and Safety of Clobazam in Patients with Hot Water Epilepsy. [9] (n.d.). Valproate for Reflex Epilepsies, Including Hot Water Epilepsy.

Hot water epilepsy (HWE) can be differentiated from other seizure events through a thorough history and ictal video-EEG recordings.

• Syncope: HWE can be distinguished from syncope by its characteristic seizures triggered by immersion in hot water. Unlike syncope, which is often caused by a sudden loss of blood flow to the brain, HWE is a form of reflex epilepsy that occurs in response to a specific stimulus (hot water) [1].
• Other seizure events: Differential diagnosis with other seizure events, such as febrile seizures or status epilepticus, can be achieved through ictal video-EEG recordings. These recordings help to identify the unique characteristics of HWE and distinguish it from other paroxysmal events [5].

In addition, few ictal recordings are available for HWE, which makes differential diagnosis even more challenging. However, with a thorough history and careful analysis of the patient's symptoms, it is generally possible to differentiate HWE from other seizure events.

References: [1] S Yimenicioğlu (2024) - Hot water epilepsy can be distinguished from syncope by its characteristic seizures triggered by immersion in hot water. [5] CJ Stutchfield (2014) - Differential diagnosis with other seizure events, such as febrile seizures or status epilepticus, can be achieved through ictal video-EEG recordings.