Exploring Pre- and Postoperative Profiles of Hot Water Epilepsy: Revisiting Pathogenic Mechanisms

Hot water epilepsy (HWE) refers to a rare form of reflex epilepsy precipitated by the stimulus of pouring hot water over the head or by bathing. Despite being most commonly seen in southern India, isolated HWE cases have surfaced in western countries. HWE classically manifests as simple or complex partial with temporal lobe semiology. About a quarter of patients show interictal EEG abnormalities, which mostly occur over the temporal lobes. HWE has two established variants that are typically benign. We present two cases where HWE preceded spontaneous seizures, which later progressed to pharmacoresistant epilepsy. These cases garner further evidence for a symptomatic variant of HWE. Additionally, clinical features of HWE are discussed and an updated model of pathogenesis incorporating self-inducement phenomenon is proposed.