The clinical and electroencephalographic features of 21 patients with hot water epilepsy (HWE) have been analysed at the University of Istanbul, Turkey. The male:female ratio was 3:1. Age at onset of seizures ranged from 19 months to 27 years (mean, 12 years). Seizures were precipitated by pouring water over the head in 14 cases or by bathing in hot water. Nine expressed a pleasurable feeling during the seizures. Seizures were partial in 20, with secondarily generalized in 8, and generalized in 1. Spontaneous seizures also occurred in 62%. EEGs were abnormal in 8, with focal temporal epileptiform discharges. Neuroimaging was normal in 12 patients studied. Seizures were controlled by avoiding hot water in 7 patients. One patient who induced seizures compulsively was treated with carbamazepine (CBZ). The remaining patients responded to CBZ or valproate. 
COMMENT. Hot water epilepsy (HWE), a rare form of reflex epilepsy, has a male preponderance, may be self induced, often for pleasure, and shows temporal lobe localization of EEG epileptiform discharges. It is generally self-limited, controlled by avoiding hot water-head baths or showers, but antiepileptic medication is sometimes required.
HWE is a regional religious custom in Southern India, where 279 patients were studied between 1980-83. Ages ranged from 8 mos to 58 years, 28% below 6 years. Only 7% had febrile convulsions. Complex partial seizures occurred in 67% and generalized tonic-clonic seizures in 33%. Spontaneous seizures also occurred in 30%. A positive family history of epilepsy was obtained in 22% and for HWE in only 7% . See Progress in Pediatric Neurology I, PNB Publishers, 1991;pp43-44.