Chapter 102 - Hot-water epilepsy

Summary

Hot-water epilepsy (HWE) is precipitated by the stimulus of bathing in hot water poured over the head. It is also known as water-immersion epilepsy or bathing epilepsy. To understand the pathophysiological and pharmacological mechanisms underlying HWE, an experimental animal model that mimics the precipitating stimulus, the ictal events, and the electroencephalographic features has been developed. Patients with HWE seem extremely sensitive to the rapid increase in temperature occurring during hot-water head baths, which precipitates seizures. This aberrant thermoregulatory response may be genetically determined. Hyperthermic kindling was demonstrated in this model by repeated hot-water stimulation. In the absence of apparent structural changes in magnetic resonance imaging (MRI) of HWE patients it is likely that functional neuronal changes underlie seizures. Often HWE is managed in two ways: using lukewarm water for a head bath or sponging with hot towels and use of conventional antiepileptic drugs (AEDs) such as phenytoin or carbamazepine.