Abstracts

INTRODUCCION The Term reflex epilepsy describes a seizure precipitated by an external sensory stimulus. The role of stimuli in provoking seizures has been known since 1850s; several types of seizures have been described since then (1). In approximately 5% of epilepsy patients, seizures triggered off by a specific sensory stimulus (2). Certain epileptic seizures are regularly precipitated by specific stimuli. Most of these stimuli are sensory in nature, but some are represented by complex activities involving several different sensory systems or higher brain functions (for example listening music or reading epilepsy). Intermittent light is by far the most common sensory precipitant of seizures (3). Hot water epilepsy is a rare disorder in our medium; this is precipitated by the stimulus of bathing with hot water. PURPOSE: Our aim is to outline the clinical and video-electroencefalographic (V-EEG) features of one patient with hot water epilepsy (HWE), a rare and unique form of reflex epilepsy. PATIENT AND METHOD: Male 7 months old, presented paleness, hypotonia and loss of consciousness at the hot water immersion per 15 seconds and somnolence during two hours. The patient was examined in cardiac, neurologic and biochemical aspects. Electrocardiogram, Magnetic Resonance Imaging (MRI) laboratory test and the clinical exam were normal. Interictal electroencephalogram (EEG) recording was normal too. Video-EEG was performed during the immersion in hot water at 35 C, repeating the event described with clinic and electroencephalographic correlation. The patient was managed with valproic acid for three months and avoided the immersion in hot water; he is free of seizures without treatment since 25 months ago with normal neurodevelopment. DISCUSSION: The underlying mechanisms of HWE remain unclear; some may have a genetic basis with added environmental influence. In HWE the interictal EEG is usually normal, but 15-20% might show diffuse abnormalities, the neuroimaging is also normal in the majority of reports. The seizures are described as partial, (67%), or generalized tonic clonic (33%). Our patient had most of the characteristics described by other authors CONCLUSIONS: Hot water epilepsy is a benign reflex epilepsy. Lowering water temperature and changing the method of bathing must be the first step for the treatment. If needed, antiepileptic drugs should be considered as an additive treatment.