[Hot water epilepsy: a benign and underestimated form]

Hot water epilepsy with pachygyria

Hot water epilepsy (HWE) refers to a specific type of reflex epilepsy precipitated by the stimulus of bathing in hot water. Pathogenesis is still unknown and temporal lobe has been thought to take part in the epileptogenesis. HWE can be symptomatic of focal cortical malformation, and few cases were reported. This is the third report of HEW in which a parietal malformation has been observed. Our hypothesis that sensory cortex might be implicated in the epileptogenic process is corroborated by two previous reports on patients with HWE and malformation of the parietal cortical development.

Intra-familial incidence and characteristics of hot water epilepsy

OBJECTIVE

To assess the clinical features of several members of the same family diagnosed with both hot water epilepsy (HWE) and cerebral lesions.

METHODS

Age at onset and types of seizure, precipitating factors, EEG findings, and neuroimages were evaluated.

RESULTS

The family consisted of six generations, including one consanguineous parent. Of eight family members diagnosed with epilepsy, seven suffered from HWE. Age at onset of seizures ranged within childhood. Seven patients with HWE experienced complex partial seizures, with or without secondary generalization; one experienced simple partial seizures as well as complex partial seizures. Three patients experienced spontaneous seizures as well as HWE. Interictal EEG revealed abnormalities in two patients. Magnetic resonance imaging revealed cerebral lesions in one patient, probably attributable to ischemic changes. Magnetic resonance images were consistent with findings of ischemic gliosis in two patients, and either demyelinating or ischemic gliosis in one patient.

CONCLUSIONS

Descriptions of HWE families with different ethnic backgrounds may permit more definite conclusions regarding the mechanisms epileptogenesis, and the genetic defects that underlie this disease.

Hot water epilepsy and focal malformation of the parietal cortex development

Hot water epilepsy (HWE) refers to a specific type of reflex epilepsy precipitated by the stimulus of bathing in hot water. HWE is considered to be a geographically specific epileptic syndrome since it mainly occurs in the Indian community. Spontaneous seizures may also occur later in life. The seizure pattern includes complex partial attacks. Although the pathogenesis of HWE is still unknown, temporal lobe has been thought to take part in the epileptogenesis. This paper reports on a 4-year-old girl who, at the age of 6 months, experienced complex partial seizures triggered by bathing in hot water. Non-provoked seizures intercritical EEG showed isolated spikes and spike-and-waves in the left parietal region. Brain MRI detected a left parietal focal cortical dysplasia. This is the second patient with HWE in whom a cortical malformation has been observed. The observation present here and data reported in the literature seem to indicate that the sensory cortex might also be involved in triggering seizures precipitated by a bath in hot water. Moreover, the authors believe that MRI examination should be considered for this group of patients.

Skin cleansing in children

The problems of skin cleansing in infants have been re-evaluated in recent years on the basis of current understanding of cosmetology and skin physiology. The anatomical and functional peculiarities of infant's skin have been elucidated and, although it is known that the barrier function is established at birth in normal babies, it remains the case that children's skin is more delicate and therefore more prone to irritant and allergic contact dermatitis. These factors determine the choice of cleansing agents during infancy. The products available on the market differ markedly. Indeed detergents, bath oils, bath powders, due to their distinctive properties, have different indications and different benefits. The method of cleansing the skin, i.e. bathing or showering, is also important. The frequency of cleansing should take into account the age and the degree of exposure to pollutants. For special purposes, e.g. impetiginized dermatoses, antiseptics such as potassium permanganate or chlorhexidine can be added to the water in appropriate concentrations. The ideal paediatric detergent should be very mild to avoid irritant dermatitis, and very simple to avoid allergic dermatitis.