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Letters to the Editor Indian Pediatrics 2002; 39:879-880 |
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Hot Water Epilepsy |
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Flickering light and color patterns, reading, language, movement, decision making, eating, tapping and touching, auditory stimulation and hot water immersion can induce seizures in some epileptic patients. These are called reflex epilepsies. Hot water epilepsy (HWE) is a form of hyperthermia induced reflex epilepsy, reported most frequently from South India(1) though occasional cases have been reported from other parts of the world. The trigerring stimulus is a bath or shower in hot water. We report a case of HWE from North India. A six year old boy presented with history of seizures while taking bath with hot water since the age of three years. While taking bath with hot water, he used to become motionless with activity arrest. This was associated with vacant stare, uprolling of eye balls, frothing from mouth, cynosis and tonic clonic movements. The seizure episodes could be reproduced during hospitalization. Seizure episode were never reported while taking bath with cold water during summer months. The child was born by normal vaginal delivery at home with uneventful perinatal period. There was no history of seizures during any febrile illness, head injury, suppurative otitis media or similar complaint in the family. The growth and development was within normal limits with no neurocutaneous stigmata. The child had received many antiepileptic drugs including phenobarbitone, phenytoin, carbamazepine and sodium valproate but there was no relief. Fundus examination, EEG and plain and contrast CT scan head were normal. The child was hospitalized and all the antiepileptic drugs were stopped. Temperature of hot water for bath was measured and gradually lowered. He continued to have seizures with hot water when temperature was more than 38ºC, but there was no seizure when the temperature of water was kept at or below 37ºC. He was discharged with the advice to have bath with water temperature at or below 37ºC. The child is under regular follow up for the last one year with no recurrence of seizures. Hot water epilepsy precipitated by bath or shower in hot water, has been described infrequently in literature. Largest number of cases of HWE have been reported from Southern India(1). In this series, HWE constituted 4.4% of all complex partial seizures and generalized tonic clonic seizures. HWE was found to be more common in boys. Prognosis was reported to be favorable, but 25% of cases developed nonreflex epilepsy within 1-3 years. In six cases of HWE reported by Loos et al(2), seizures were provoked by hot water bath and treatable by decreasing the bath temperature. All the cases were between the age of six months to two years. The physiopathogenic mechanisms are usually complex. The carebral cortex corresponding to the function which induces epileptic crisis is hyperexcitable, and is the cause of an identifiable lesion or dysfunction without an underlying lesion(3). In an animal model for HWE it was found that there are two factors that possibly determine seizure proneness(4). These are (i) rate of rise in core body temperature being more than 1.5ºC/min and (ii) an accompanying rise in regional brain (hippocampal) temperature. In absence of either, seizures could not be produced. In our case there were no adverse perinatal factors and he was symptom free till the age of three years. EEG and CT scan did not reveal anything. A case has been reported where contrast CT scan and MRI were normal, not revealing any structural lesion but interictal SPECT showed a hypometabolism in the cerebral region(5). However neuroimaging studies have been rarely performed in this uncommon type of epilepsy. There is no need to use antiepileptic drugs in HWE and lowering the both temperature may alone is sufficient to control the seiqures. Milap Sharma, V.K. Sharma, R.K. Kaushal, Sanjeev Chaudhary, Dr. R.P.G.M.C. Hospital, Dharamshala, and Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. . |
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