Hot water Epilepsy

Poster on Hot water Epilepsy

1. 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 N eurocutaneous 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 C lobazam . 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. Antenata l 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 B athing epilepsy. Stimulus - T hermal cutaneous stimulus Semiology - P artial 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