Video and EEG documentation of seizures induced by showering in 2 photosensitive patients

Aims: espacially from india there are case reports of patients with so called hot water epilepsy. It could be shown experimentally that in these patients stimulation with hot water had a kindling-like effect with increasing convulsive answers on stimulus. We report of a young patient, in which we could document showering-induced seizures.

Case report: 17year old patient, since 14. year of life showing under stimulation with light (disco), while washing the face and by showering jerks, partially with losing consciousness. In EEG we saw interictal generalized poly-spike-waves. While photostimulation or stimulation with cold (!) water generalized seizure patterns and provocing of generalized tonic-clonic seizures. In MRI we saw multiple focal demyelinisations in paraventricular medullary layer. No other signs of inflammatory or immunologic desease. Patient is now seizure free on levetiracetam.

Conclusion: Typical features of hot water epilepsy – such as inducing seizures by hot water, presence of focal temporal or parietal lobe epilepsy, self-stimulation in the patients – are not found in our patient. In all propability our patient is suffering of juvenile myoclonic epilepsy, even the MRI-findings could not be explained definitively. Reflex epilepsies are often described in this syndrome. To avoid accidents it can be important to know showering as a seizure inducing mechanism.