Institutional members access full text with Ovid®

Share this article on:

Seizures Induced by Exiting Water: A Unique Form of Reflex Epilepsy

Appavu, Brian MD*; Fox, Jordana DO; Little, Robert MD; Kerrigan, John F. MD; Obeid, Makram MD§,∥

doi: 10.1097/NRL.0000000000000138
Case Report/Case Series

Introduction: Reflex epilepsies represent a form of epilepsy in which unique modes of seizure precipitation are characterized by endogenous or exogenous stimuli. Hot water epilepsy represents a subtype of reflex epilepsy in which seizure precipitation arises from the act of immersing the head with hot water. Bathing epilepsy represents another subtype of reflex epilepsy in which seizure precipitation arises from the immersion with water at lukewarm temperatures.

Case Series: We report on 2 boys with a unique form of bathing epilepsy characterized by the act of exiting out of water. The first patient had a family history significant for a brother with frontal lobe epilepsy. He underwent an evaluation in the epilepsy monitoring unit in which a reflex seizure was recorded while exiting the shower. This seizure was characterized by an ictal onset in the left frontal lobe and subsequent secondary generalization. The second patient initially had nonreflex seizures arising from the left temporal lobe and went on to develop reflex seizures upon exiting water. For both patients, the precipitation of seizures was independent of water or environmental temperature, exposure of specific body parts, or duration of water immersion. Both children experienced a sensation of coldness, followed by convulsive or atonic activity.

Conclusions: Our cases represent a unique form of bathing epilepsy in which seizure precipitation is dependent upon exiting water.

*Department of Neurology, Division of Epilepsy, Neurological Institute of New York, Columbia University Medical Center, New York, NY

Departments of Neurology

Neurology, Division of EpilepsyBarrow Neurological Institute at Phoenix Children’s Hospital, Phoenix

§Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, Comprehensive Epilepsy Center

Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut Medical Center, Lebanon

The authors declare no conflict of interest.

Reprints: Brian Appavu, MD, Department of Neurology, Division of Epilepsy, Neurological Institute of New York, Columbia University Medical Center, 710 W. 168th Street, New York, NY 10032. E-mail: bappavu@gmail.com.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.