Hot Water Epilepsy in Children: A Rare Form of Reflex Epilepsy

Aim: We evaluated the clinical and electroencephalography (EEG) characteristics, treatments, and outcomes of children with hot-water epilepsy (HWE), a specific type of reflex epilepsy. Materials and Methods: This retrospective study included 11 children who were followed-up for HWE in a pediatric neurology department between 2005 and 2022. Results: Eight children (73%) were boys and three (27%) were girls. The mean age was 60.7 +/- 30.8 months (range 11-110) and the mean age at seizure onset was 57 +/- 31.7 months (range 11-108). The mean follow-up duration was 20 months (range 10-32 months). The seizure type was identified as focal onset impaired awareness in six cases (54%) and generalized tonic-clonic seizures in five patients (46%). Four (36%) patients experienced spontaneous seizures. Interictal EEG was abnormal in two patients (18%). Four patients with spontaneous seizures were initially recommended bathing with lukewarm water and continuous anti-seizure medications. Three patients with reflex seizures benefited from lukewarm bathing and achieved seizure control. Two patients with uncontrolled reflex seizures were seizure-free after clobazam prophylaxis. Two patients who were unresponsive to lukewarm bathing and clobazam were started on continuous anti-seizure medications. In total, six patients were on continuous anti-seizure medications. Conclusion: Despite its benign nature, HWE should be identified and appropriately treated due to the risk of spontaneous seizures. It is also important to determine the triggeringfactors so that appropriate bathing with lukewarm water and intermittent clobazam prophylaxis can be initiated. Spontaneous seizures require anti-seizure medications.