Hot water reflex epilepsy

Hot water reflex epilepsy (HWE), also known as hot water epilepsy or bathing epilepsy, is a rare form of reflex epilepsy in which seizures are triggered by contact with hot water, most commonly during bathing or pouring hot water over the head or body. The condition predominantly affects the central nervous system, with seizures believed to originate from temporal or frontal lobe regions. It was first described in populations from southern India, where the practice of bathing with hot water poured over the head is common, though cases have been reported worldwide. Seizures in HWE are typically complex partial (focal with impaired awareness) in nature, often presenting with a sensation of fear, epigastric aura, staring, automatisms, and sometimes secondary generalization to tonic-clonic seizures. The temperature of the water and the body region exposed (particularly the head) appear to be critical triggering factors. Some patients may also develop spontaneous seizures unrelated to hot water exposure over time. Onset is most commonly in childhood or adolescence, though it can occur at any age. Management of hot water reflex epilepsy primarily involves avoidance of the triggering stimulus — specifically, reducing water temperature during bathing and avoiding pouring hot water directly over the head. Antiepileptic medications such as clobazam, carbamazepine, and valproic acid may be used, particularly in patients who also develop spontaneous seizures. Intermittent prophylactic use of benzodiazepines before bathing has also been reported as a strategy. A familial predisposition has been observed in some cases, suggesting a genetic component, though the precise genetic basis remains incompletely characterized. The prognosis is generally favorable with appropriate trigger avoidance and, when needed, pharmacological treatment.

Common questions about Hot water reflex epilepsy