hot water epilepsy ( hwe ) is a well - defined entity within the forms of reflex epilepsies , which occurs while bathing with hot water . allen first described hwe in 1945 and subsequently there have been many reports of its prevalence in both children and adults . hwe is a term used to encompass a reflex epileptic condition , characterized by pouring hot water ( 4050c ) on the head . although it has been reported from all parts of the world , it is more prevalent in south indian population as most of the reported cases have been from there . it has been rarely reported in other european countries and isolated case reports have been published from japan and turkey . the differences among countries may depend on climatic conditions , bathing habits and probably genetic susceptibilities . here , a 1-year - old saudi male child had presented to the emergency ward with history of generalized seizures . mother noticed that after pouring hot water on the head , while giving the ritual bath , the child suddenly became floppy and developed generalized seizures with loss of consciousness . mother admitted that there was family history of similar seizures in her sister 's child , following hot water bath . while examination , the child was afebrile , conscious , moving all four limbs and there were no long tract signs . routine blood tests , including complete blood count , biochemistry and neuroimaging [ magnetic resonance imaging ( mri ) brain study ] as well as sleep eeg were within normal limits . diagnosis of hwe was made and the parents were counseled regarding its benign course and no anti - epileptic medications were prescribed . parents were advised to reduce the temperature of the water to tolerably lower levels , while giving bath to this child . in the follow - up visits , although the seizure recurrences were not encountered , there was one episode of minor motor fit when the boy stepped into the bath tub with his elder brother , accidentally . parents were convinced about the problem of their child and were aware of the correct temperature of the water which would not trigger the seizures in him . an 11-year - old saudi girl was referred for the evaluation of seizure disorder ; she was diagnosed with epilepsy elsewhere and was on regular anti - epileptic medication , namely sodium valporate . on questioning , she had been getting generalized brief convulsions whenever she was bathing with hot water and there was no improvement with the above medication . she admitted that splashing water only on her body never induced seizures on her , while a head bath had invariably precipitated it . there was no family history of seizures and , interestingly , though the father was of saudi origin , her maternal grandparents were from india . apart from routine blood tests , eeg and mri brain studies were done and showed normal reports . genetic studies could not be offered because of the technical as well as financial constraints . the father and the patient were counseled in detail regarding the water temperature reduction while bathing and the medication was withdrawn . in the follow - up visits , the patient had a few infrequent seizures initially and later she became seizure - free after water at the correct temperature was used , as per our advice . a 1-year - old saudi male child had presented to the emergency ward with history of generalized seizures . mother noticed that after pouring hot water on the head , while giving the ritual bath , the child suddenly became floppy and developed generalized seizures with loss of consciousness . mother admitted that there was family history of similar seizures in her sister 's child , following hot water bath . while examination , the child was afebrile , conscious , moving all four limbs and there were no long tract signs . routine blood tests , including complete blood count , biochemistry and neuroimaging [ magnetic resonance imaging ( mri ) brain study ] as well as sleep eeg were within normal limits . diagnosis of hwe was made and the parents were counseled regarding its benign course and no anti - epileptic medications were prescribed . parents were advised to reduce the temperature of the water to tolerably lower levels , while giving bath to this child . in the follow - up visits , although the seizure recurrences were not encountered , there was one episode of minor motor fit when the boy stepped into the bath tub with his elder brother , accidentally . parents were convinced about the problem of their child and were aware of the correct temperature of the water which would not trigger the seizures in him . an 11-year - old saudi girl was referred for the evaluation of seizure disorder ; she was diagnosed with epilepsy elsewhere and was on regular anti - epileptic medication , namely sodium valporate . on questioning , she had been getting generalized brief convulsions whenever she was bathing with hot water and there was no improvement with the above medication . she admitted that splashing water only on her body never induced seizures on her , while a head bath had invariably precipitated it . there was no family history of seizures and , interestingly , though the father was of saudi origin , her maternal grandparents were from india . apart from routine blood tests , eeg and mri brain studies were done and showed normal reports . genetic studies could not be offered because of the technical as well as financial constraints . the father and the patient were counseled in detail regarding the water temperature reduction while bathing and the medication was withdrawn . in the follow - up visits , the patient had a few infrequent seizures initially and later she became seizure - free after water at the correct temperature was used , as per our advice . reflex epilepsy is a condition in which seizures are provoked exclusively by an external stimulus and account for 6% of all epilepsies . hwe is an unusual form of reflex epilepsy , precipitated always , by bathing in hot water . both partial and generalized tonic seizures have been described secondary to hot water bathing , suggesting that the seizures might be influenced by the same afferent pathway . most of the reported cases in the past were from southern parts of india and none of our patients had their origin from there , as they were born to saudi parents , although the first saudi patient 's mother had an indian origin . hot water is known to precipitate severe myoclonic epilepsy in infants , but hwe is an unique form of generalized or partial tonic , clonic seizures , even reported exceptionally with cold water , during tub bathing or taking a shower . the exact mechanism of hwe remains uncertain and seizures had been reported during a bath even when water is not poured over the head . ritual immersion baths at temperature around 45c are reported to trigger epileptic fits . at this higher temperature of water thus , an aberrant thermo - regulatory center , which is sensitive to sudden spurt in regional temperature following hot water bath , could be the precipitation cause for hwe . another reasonable mechanism , described on physiological grounds , could be a defective inhibitory influence over afferent volleys of somatosensory stimuli such as warm or hot water poured over large body surface . in this context , hwe could be comparable to febrile seizures in the above - suggested mechanism of occurrence , although fever - induced fits were not significant in these patients . an experimental animal model mimicking hwe has been developed in order to understand the pathophysiological mechanism . familial clustering in hwe has suggested a genetic component as the probable cause of the disorder and a genetic locus in the 10th chromosome had been identified ( 10q21,3-q22,3 ) . the diagnosis is entirely based upon history only , as inter - ictal electroencephalography and neuroimaging studies were reported to be normal . shankar et al . had reported autopsy findings in three patients with hwe and concluded that there could be an aberrant thermoregulation in such genetically susceptible patients with possible environmental influences . reframed the term as bathing epilepsy rather than hot water epilepsy because their patients had seizures with warm water but not with hot water . postulated altered autonomic regulations or some form of channelopathies as the underlying mechanisms for this disorder . satishchandra related this disorder as a form of geographically specific epilepsy syndrome , where some cases might have genetic basis with added environmental influence . there is no role of anti- epileptic treatment in hwe because of its symptomatic nature of seizures ; altering the temperature of water or changing the method of washing would prevent the occurrence of these seizures . anti - epileptic drugs are only indicated when such patients continue to have seizures even during regular baths with normal water temperature or non - reflex seizures . since seizures show a tendency to decrease spontaneously , withdrawal of medication , if it had been given , should be carefully undertaken only after several months . the above two case descriptions were made to highlight the rarity of its occurrence and to emphasize that hwe could be controlled exclusively by lifestyle modification without resorting to anti - epileptic medication .