doi:10.1016/j.braindev.2005.08.006 
Copyright © 2005 Elsevier B.V. All rights reserved.
Case report
Hot water epilepsy occurring at temperature below the core temperature
Stéphane Auvina, 
, 
, Marie-Dominique Lamblinb, Florence Pandita, Maria Bastosa, Philippe Derambureb and Louis Valléea
aDepartment of Pediatric Neurology, University Hospital, Lille, France
bDepartment of Neurophysiology, University Hospital, Lille, France
Received 30 March 2005;
revised 16 June 2005;
accepted 14 August 2005.
Available online 10 January 2006.
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Abstract
A 6-year-old girl had water reflex epilepsy occurring at lower temperature than the core temperature. Seizures episodes consisted of a loss of consciousness absence followed by left predominant hypotonia with right fronto-temporal high voltage slow waves on the ictal-EEG. Seizures were only observed when the water was poured on scalp or face. Neuropsychological evaluation showed frontal dysfunction (Rey's figure). MRI study was normal. Oxcarbazepine permitted the disappearance of seizures and an improvement of executive disorders. In this case, the pathophysiological mechanism cannot be a hyperthermic related event. The temperature control as treatment of hot-water epilepsy could be used after the exploration of its implication in seizure induction.
Keywords: Reflex epilepsy; Hot-water epilepsy; Ictal-EEG
Fig. 1. Picture from the video-EEG when the left hypotonia was noted. This picture has been taken from the video-EEG at 9:16 AM. The record started at 9:14 AM.
Fig. 2. (A) Ictal-EEG (first part). Clinical observations following the seizure were noted on the figure by arrows: (1): she said: ‘There is lots of water on the mirror’ (62 s after the mother started to pour the water over her head); (2): she pushed the shower; (3): she breathed in; (4): loss of consciousness (74.5 s after the mother started to pour the water over her head). Ictal-EEG showed a generalized slow waves discharge with a predominance on the right fronto-parietal regions. (B) Ictal-EEG (second part). Clinical observation consisted of the appearance of hypotonia at the end of the seizure (arrow; 87.5 s after the mother started to pour the water over her head). Ictal-EEG showed a generalized spike-wave discharge with predominant on the right fronto-parietal regions. The consciousness recovery was noted 96 s after the mother started to pour the water over her head. The muscular tone normalized in about 4 min.
Fig. 3. Rey's figures realized by our patient. (A): Figure realized at diagnosis without treatment. The patient used a type V strategy to draw the figure (copy details of the drawing without organisation, most frequent at 4-year-old). The spatial organisation of the drawing showed orientation disorder with a left/right and up/bottom confusion. (B): Figure realized one year after the start of the treatment. The patient used a type IV strategy to draw the figure as expected at this age (copy parts of the drawing without global organisation). The spatial organisation was improved.
Abstract
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