This case report describes a 2 year old boy who experienced seizures when taking baths in hot water. The boy's seizures were characterized by sudden loss of consciousness and tonic stiffening of the limbs, lasting a few minutes. His seizures were triggered by bathing in hot water (40-50°C), but could be prevented by bathing in normal temperature water. He was diagnosed with hot water epilepsy (HWE), a rare form of reflex epilepsy precipitated by the thermal cutaneous stimulus of hot water on the skin. Treatment involved lowering the water temperature and giving intermittent anti-seizure medication before baths to prevent further triggered seizures.

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• Seizures that precipitated by a sensory
stimulus are described as “reflex or sensory
epilepsy”. One of such epilepsy is precipitated
by the stimulus of bathing with hot water
pouring over the head and is better known as
hot water epilepsy (HWE).
• HWE is a term used to encompass a reflex
epileptic condition, characterized by pouring
hot water (40–50°C) on the head.
• Described first in 1945 in New Zealand-
reported from all parts of the world. Its more
common in South Indian population with the
prevalence rate of 60 per 100,000. Prevalence
of 255 per 100,000 has been documented from
a rural area called yelandur(Near Mysore).
• Here, we report a case of HWE in a 2 year
old boy.
INTRODUCTION
CASE REPORT
• Head Circumference and weight for height
were in Normal Limits.
• No Neurocutaneous markers
• Neurologically normal
• We witnessed the child while pouring hot and
normal temperature water over the body/ head-
complex partial seizure with tonic stiffening
lasted for 30 to 40 seconds was recorded.
COURSE
• Initially tried bathing in water of normal
temperature- episodes recurred but were of
very short duration and minimal intensity.
• Options were discussed and decided on
starting Clobazam 1 hour before every bath.
•1:1 Bath:Seizure ratio became 4:1 in the first
month and 30:1 in the third month with
Intermittent Clobazam.
•On follow up, he had an episode of
untriggered seizure during sleep hence he was
started on Regular AED- Valproate.
Since then has been event free for 1 month.
•EEG –Generalised Epileptic Wave Forms.
•CBC- Iron deficiency anemia.
CONCLUSION
• Hot water epilepsy is a rare form of benign
reflex epilepsy.
• Lowering water temperature must be the first
step for the treatment.
• Antiepileptic drugs should be considered if
untriggered seizures.
• This case report is to increase the awareness
about this rare epileptic condition among
pediatricians.
REFERENCES
1.Satishchandra P, Shivaramakrishna A,
Kaliaperumal VG. Hot water epilepsy:
Avariant of reflex epilepsy in parts of South
India. J Neurol. 1985;232(Suppl):212.
2.Mani KS, Gopalakrishnan PN, Vyas JN,
Pillai MS. “Hot-water epilepsy” - A peculiar
type of reflex epilepsy. A preliminary
report. Neurol India. 1968;16:107–10.
3.Shaw NJ, Livingston JH, Minns RA, Clarke
M. Epilepsy precipitated by bathing. Dev Med
Child Neurol. 1988;30:108–11.
4.Subrahmanayam HS. Hotwater
epilepsy. Neurology (India) 1972;20(Suppl
2):241–3.
5.Szymonowicz W, Meloff KL. Hot water
epilepsy. Can J Neurol Sci. 1978;5:247–51.
6.Gastaut H. Dictionary of epilepsy. Part
I. Geneva: World Health Organization; 1973.
7.Velmurugendran CU. Reflex epilepsy. J
Neurol. 1985;232(Suppl):212.
8.Mofenson HC, Weymuller CA, Greensher J.
Epilepsy due to water immersion: an unusual
case of reflex sensory
epilepsy. JAMA. 1965;191:600
• 2 year old boy from Ulundurpet was brought
with multiple episodes of sudden onset loss of
consciousness with tonic stiffening of limbs,
lasting for a few minutes while taking bath in
hot water for 6 months.
• No clonic limb movements
• Hence the child was bathed only once in 15
days.
• Milestones were appropriate for age except
for Speech Delay and Hyperactivity.
• Antenatal and Natal History was Uneventful.
• No family history of Epilepsy.
DR. N.ZAHEEN ZEHRA, DR. LALITHA. M, Dr. MANJU MARY VARGHESE, PROF. D. GUNASEKARAN
MGMCRI, PUDUCHERRY
HOT WATER EPILEPSY : A RARE FORM OF REFLEX EPILEPSY
EXAMINATION
•HWE is a well defined form of reflex epilepsy
that occurs while bathing in hot water.
•Otherwise known as Bathing epilepsy.
• Stimulus - Thermal cutaneous stimulus
• Semiology- Partial with secondary
generalization, generalized tonic type. Clonic
limb movements are rare.
• Studies have shown CPS in 58.5%.
41.5% showed CPS with Secondary
generalization.
•62% of the subjects develop spontaneous
seizures in due course of illness.
PATHOPHYSIOLOGY
• An aberrant thermo-regulatory center, which is
sensitive to sudden spurt in regional
temperature following hot water bath, could be
the precipitation cause for HWE.
• Another mechanism described could be a
defective inhibitory influence over afferent
volleys of somatosensory stimuli such as warm
or hot water poured over large body surface.
• Mechanism similar to that of Febrile Seizures.
• Two loci for HWE at chromosome 10q21.3-
q22.3 and 4q24-q28 have been identified.
DIAGNOSIS
• The diagnosis is entirely based on history
TREATMENT
• Anti-epileptic drugs are only indicated when
patients continue to have seizures even during
regular baths with normal water temperature or
spontaneous seizures.
•Intermittent Prophylaxis with Clobazam can be
given before a hot water shower.
•Seizures frequency decreases spontaneously
over time.
DISCUSSION
INVESTIGATIONS