Dr Rohith PS
Hot water epilepsy (HWE) is a type of reflex epilepsy which occurs when hot water is poured over the head , face, neck, or trunk during bathing. Two types of hot water epilepsies exist: the classical one seen in older children and adults, which is usually triggered by head baths, and a variant seen in infants precipitated by immersion of the lower trunk in hot water
These were also known as water-immersion epilepsy or bathing epilepsy. HWE is a term used to encompass a reflex epileptic condition, characterized by pouring hot water (40–50°C) on the head. Although it has been reported from all parts of the world, it is more prevalent in the Southern Indian population as most of the reported cases have been from there.
This was first described from New Zealand in 1945, there were isolated reports from all round the world: Australia, United States of America, Canada, United Kingdom, and Japan. A cohort study done by two researchers K.S.Mani and P.Satishchandra on 279 cases of hot water epilepsy from university hospital and teritiary care center, National institute of mental health and neuroscience(NIMHANS),was evaluated over 4 year period(1980-1983) shows that large number of patients with hot water epilepsy have been reported in India , particularly south India.
A House-to-house Bangalore urban-rural neuroepidemiologic survey of 102,557 population from South India, reported that HWE accounts for 6.9% of all epilepsies in this community, giving a prevalence rate of 60 per 100,000 (unpublished data). Mani et al., published an epidemiologic study from Yelandur, a rural area near Mysore from Karnataka, and quoted a prevalence rate of 255/100,000 for HWE. The classification proposed by the International League Against Epilepsy task force in 2001 includes HWE under the reflex epilepsies. In a recent study from this center on 70 patients, majority of the patients belonged to Mandya: 30.5%, Ramanagara: 30.0% and Mysore: 15.2% districts of Karnataka.
The pathogenesis for Hot Water Epilepsy is not known only some hypothesis are there, one hypothesis put forward by Stensman and Ursing suggested that this type of epilepsy is precipitated by complex tactile and temperature dependent stimuli. Although, it was possible to provoke the seizure in the laboratory by pouring hot water over the heads of these patients, hot-water towels, sauna, or blowing hot air on the head failed to induce seizures, suggesting that the triggering stimulus is complex and would involve a combination of factors such as (a) contact of scalp with hot water, (b) temperature of water, and (c) specific cortical area of stimulation. As the Complex Partial Seizures are the commonest variety of seizure, and ictal EEG had demonstrated focal activity in the temporal or frontal lobe, Syzmonowicz and Meloff suggested that there could be a structural lesion in the temporal lobe. However, computed tomography (CT) and magnetic resonance imaging (MRI) in patients with HWE have Anegated the presence of any focal structural lesions in the majority. Even if such lesion were present, it is still not clear whether the mechanism of seizure depends on locally increased neuronal excitability in the lesions, or pathologic involvement of lower centers such as hypothalamus, or both. From 11% to 27% of the HWE patients reported from India had history suggestive of febrile convulsions before the development of this reflex epilepsy. This association has not been noted from other parts of the world.
Hot Water Epilepsy in human are often managed in two ways: (a) using lukewarm water for a head bath or sponging with hot towels and (b) use of conventional antiepileptic drugs (AEDs) such as phenytoin (PHT).
HOMOEOPATHIC RUBRICS AND MEDICINES FOR HOT WATER EPILEPSY
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CONDITION OF AGGRAVATION AND AMELORATION IN GENERALS- BATHING AND WASHING-HOT WATER-AGGRAVATION-APIS,ARG-N,BELL,BRY,CARB-V,GELS,IOD,LACH,NAT-M,PULS,SEC,SULPH,OP
- Bores head into pillow and screams out. Rolling of head from side to side in hydrocephalus
- Great anxious restlessness and fidgety. Allergic edema of face, eyelids, lips, mouth and throat
- Face red hot swollen with piercing pain or waxy pale and edematous, lips bluish
- Extend from right to left
- Great inclination to sleep but cannot from nervous restlessness
- Screams and suddenly starting from sleep
- Modalities-better from cold air, cool bathing, uncovering
- Worse from heat of room, hot weather, hot drinks, bath, bed
- It act very quickly and violently
- Heat in head and throbbing headache.
- Glonoine acts upon the circulation where it causes violent pulsations and irregular congestion
- Sensation of pulsation throughout the body
- Head-cerebral congestion, throbbing and bursting headache, waves of terrible pounding headache. Holds the head tightly, head feels large as if skull were too small for brain.
- Extremities- trembling of hands, fingers and toes spread apart during convulsion
- Modalities- better, open air, elevating the head, cold things, cold application
- Worse-sun, open fire, heat on head, hot weather, cutting hair.
- Children who talk late, cross, irritable, cry from slightest cause. Emaciation while living well, emaciation notable in neck
- Suited to anemic , chlorotic people with catarrhal trouble, teething children
- Limbs-children do not learn to walk, trembling of hand when writing, palms hot and perspiring, numbness and tingling in fingers and lower limbs.
- Legs cold. Convulsive jerking of limbs on falling asleep
- Modalities- better- open air, cool bathing, sweating, rest, tight clothing, deep breathing, lying on right side
- Worse- 9-11 am, with sun, summer, dampness, from excertion of eyes, seashore, sympathy, violent emotion
- All complaints are characterized by a stupor. Complaints are painless and are accompanied by heavy, deep sleep, stertorous breathing.
- Opium has insensibility of the nerves, painlessness, depression, drowsy stupor torpidity and general sluggishness of function and lack of vital reaction.
- Head-confusion of head. Heavy occiput. Head hot with hot sweat. Paralysis of brain
- Limbs-trembling of the limb after fright. Twitching of limbs. jerks as if flexors were overacting. convulsion, worse from glare of light, coldness of limbs. One or other arm moves convulsively to and fro.
- Modalities-better-from cold, uncovering, constant walking
- Worse- heat, sunstroke, anxiety, fear, suppressed discharges, during and after sleep.
- The principal action of Angustra vera is on spinal motor nerves and mucous membranes
- Strong craving for coffee is a characteristic symptom
- Head – headache with heat of face
- Limbs- stiffness and tension of muscle and joints. Pain in limb on walking, coldness of fingers.
- Modalities- worse- moving arm, exertion, drinking warm milk, 3.00 pm, lying on left side.
- Belladonna acts upon nerve centers producing twitching, convulsion and pain. It produces an active congestion, furious excitement, perverted special senses, twitching, convulsions and pain.
- Belladonna stands for violence of attack and suddenness of onset, associated with hot, red skin, flushed face, dilated pupils, throbbing carotids.
- Epileptic attacks are followed by nausea and vomiting, spasm followed by prolonged unconsciousness
- Head-meningitis and sunstroke. Throbbing, hammering headache, pain worse light, noise, jar lying down and in afternoon
- Limb-jerks or spasms in limbs. shooting pain along limb
- Modalities-better- light covering, bending backward, semi erect, rest in bed, standing
- Worse- heat of sun, if heated, drafts, on head, haircut, washing head, lying down, looking on shining objects or running water.
- The neurotic effects are very marked many brain and spinal symptoms symptom of incoordination , loss of control, trembling in affected parts
- Head-nervous headache with coldness and trembling. Aching in frontal eminence with enlarged feeling in corresponding eye
- Boring pain better on tight bandaging and pressure
- Headache end in vomiting
- Limbs-lassitude and weariness of forearm and legs with trembling. Cannot walk with eyes closed. Chorea-like convulsions
- Modalities-better- from fresh air, cool air, open air, cold , cold bath, pressure, motion, belching, bending double, pressure
- Worse-mental strain, warmth in any form, night, cold food ice cream, sugar, sweet, after eating, left side
I am thankful to Dr. V.Guruprasad principal & HOD Department of Paediatrics and Dr.Muddassir.M.Mulla, Associate professor,Department of Paediatrics,GHMC Bengaluru for their constant support and guidance.
1.Satishchandra P, Sinha S. Hot-water epilepsy: From bench to bedside. Ann Indian Acad Neurol 2013 [cited 2022 Jun 17];16:137-43. Available from: https://www.annalsofian.org/text.asp?2013/16/2/137/112442
2. Murphy, R., 2000. Homeopathic remedy guide. 2nd ed. Indian books & periodicals publisher New Delhi, pp.142,746,1211,1278,118,250,167.
Dr Rohith PS
PG Scholar, Department of Paediatrics
Government Homoeopathic Medical College & Hospital Bengaluru.