A 4-year-old girl with complex partial seizures triggered by bathing in hot water and found to have a left parietal focal cortical dysplasia on MRI is reported from the University of Siena, Italy. The interictal EEG showed spikes and spike-and-wave epileptiform discharges in the left parietal region. Spontaneous non-reflex complex partial seizures recurring at 3 months after the first HWE seizure at 6 months were resistant to carbamazepine and gabapentin and controlled by topiramate. This is the second patient with hot water epilepsy (HWE) rported in association with a cortical malformation. MRI is advised in patients with HWE. 
COMMENT. HWE accounts for 6.9% of all epilepsies in the Indian community, it is also common in Turkey but rare in other ethnic groups. Children are affected more frequently than adults. First reported in an Australian patient (Lenoir et al, 1989), HWE is classified as a benign reflex epilepsy with a good prognosis, usually occurring when hot water is poured on the head, but in response to immersion in hot water in 10% of cases. Spontaneous non-reflex complex partial seizures may occur later.