Hot Water Epilepsy in a Pregnant Woman: A Case Report

Abstract

Hot water epilepsy is a unique form of reflex epilepsy precipitated by the stimulus of bathing with hot water poured over the head. It is mostly seen in infants and children, with predominance in males. We present a 28-year-old pregnant woman with reflex seizures triggered by pouring hot water over the head while having a bath during the gestation period and treated successfully with a constitutional homoeopathic medicine.

1. Case Report

A 28-year-old, three-month pregnant woman came to our clinic with the complaint of incipient seizures while having a bath by pouring hot water over the head since two months earlier. She had auras preceding her seizures. These auras were associated with feeling an epigastric sensation, staring, oral automatism, and followed by loss of consciousness.

A post-ictal state was characterised by a severe throbbing headache and drowsiness. Seizures occurred twice a month and always during bathing. Till our consultation, she had four similar seizures. She had no spontaneous seizures before the onset of her reflex seizures.

There was no family history of epilepsy and no past history of febrile convulsions, mental retardation, birth anoxia, or head trauma. Physical and neurological examinations were normal. Complete blood count, blood biochemistry, electrocardiography, interictal electroencephalography (EEG), and magnetic resonance imaging also revealed normal findings.

For avoiding the seizures, short-lasting bathing with lukewarm water instead of hot water was recommended. One month follow-up, her seizures did not stop during regular bathing. Hence, she was put on a homoeopathic treatment and she remained completely seizure-free in her entire pregnancy and even afterwards.

2. Case History

There was no significant past or family history, the only associated complaint that she mentioned was that of obstinate constipation, even with the help of laxatives, and her bowels barely moved and her few stools were rock-hard.

Her mother was accompanying her and when asked about her daughter’s nature, she stated: “She is dependable and responsible. She is punctual. She saves her money, but I don’t think she is equipped to take care of herself.”

The patient said she does not know why she had no motivation. The very idea of choosing a career and making important life choices was “overwhelming.” When she had a busy day with lots of activities, she felt better. “I work well under pressure,” she said.

Asked what was most important in her life, she said, “I haven’t stopped to think about that. I don’t have any idea. I guess I want everything to be calm and organized and not rushed. I want stability.” She dislikes being pressured to make decisions.

Her level of disinterest was appalling. She had been vegetating—doing nothing—most of her life. She seemed literally not to care about anything. Clearly, she had been, and probably still was, depressed. But it was deeper than that. It was profound apathy.

She was not at all excited about her pregnancy (or maybe unable to express her joy or sorrow) even though the decision of having a pregnancy was mutual. Though I could not gather the reason behind her apathy, it was clearly visible. Her relationship with her husband is very good. He is very much caring and is quite responsible. Her childhood was very good and without any significant history of abuse or any depression.

3. Observations:

During the whole interview she sat at one place only without any movement. She neither moved any of her limbs nor showed any concern about the surroundings. Her speech was very slow and she talked with difficulty, saying that everything felt as though it was in slow motion, as in a dream.

4. Repertorisation:

I used the following rubrics:

And the analysis that came after repertorisation was:

5. Prescription and Follow-up:

She was given Opium 200 one dose and was asked for follow-up after 15 days. During her follow-up visit after 15 days she informed me that for the first 2 days after the dose of Opium she had loose-motions but after that she again had constipation. There was no episode of epilepsy but she is feeling sleepier. There was no significant change in her mental symptoms. Sac Lac was continued for the next 15 days.

During second follow-up visit she said that there was no epilepsy and her stools were better. Then she said: “Dr., will those epileptic fits have caused any harm to the baby inside, I am worried?” This question confirmed that the prescription was right as she started showing interest in the pregnancy and she was enjoying the idea of motherhood.

There was no other episode of epilepsy in the entire pregnancy and no more repetition of Opium. This is what we call, ‘The Wonders of Homoeopathy’. Her delivery was normal and she delivered a healthy baby boy.

6. Discussion

Hot water epilepsy (HWE) is a reflex epilepsy in which the seizures are provoked by contact with hot water over the head. To date, the patho-physiologic mechanism of HWE is not known clearly but apparently the thermoregulatory system, which is extremely sensitive to the rapid rise in temperature, seems to be involved.

HWE is mostly seen in the first decade of life, with cases more frequent among males than females (70%). However, some features of our patient such as the initiation age, gender, and additional existence of gestation were different from the literature. Because of this, our case is an unusual presentation of HWE.

The pattern of epileptic seizure which is seen in HWE consists of 67% complex partial seizures and 33% generalized tonic-clonic seizures. Interictal EEG studies are usually normal like in our case whereas ictal EEG usually shows focal epileptic activities and paroxysmal discharges characterized by secondary generalization.

HWE is known as a benign and self-limited reflex epilepsy, and avoiding hot water or long showers may be sufficient to be seizure-free. However, approximately one-third of patients with HWE continue to have seizures even during regular baths. In these patients, a constitutional homoeopathic approach might be preferred as we did in our case.

7. Opium Personality

Typically, Opium is given to the type of person who exhibits extremes in their moods and behaviors, and these can be on either end of the spectrum. On one end is a sort of apathy towards life and a dulled sentiment towards pain in general.

On the other end of the spectrum, Opium is given to those who exhibit extreme hyperactivity to the extent where their sensitivity may even cause insomnia. As a result of the fact that opium may be helpful to people at both ends of the spectrum, there is a wide range of personality types that it may be helpful for.

People may go into an opium state after extreme medical issues or life events such as recovering from a brain injury or paralysis occurring as a result of a stroke, or even those going through alcohol withdrawal or experiencing delirium. This goes to show that it is most useful in the extreme instances and therefore these make up the typical remedy profile that may very well be anything but typical in nature.

The conventional Opium picture is one where one thinks of dimly lit rooms filled with fumes where people have smoked themselves into a stupor. They are only semi conscious, are unable to stand firmly or talk coherently. They demonstrate a state of peace with great sopor and desire only to be left alone. They say that there is nothing wrong, that they are perfectly well and happy, have no pains or aches, want nothing and have no symptoms to report.

Observation reveals however that they have a high temperature, are covered with a scorching hot sweat, have a rapid pulse and are delirious.  The face looks besotted, bloated, and purple; the eyes are glassy and the pupils contracted. The mind is in a state of confusion with occasional loquacity but in the main they only talk when aroused. A condition of general stupor in which the patient says nothing and does nothing prevails.

Notwithstanding the forgoing, there is an alternative state of opposing symptoms which may even be present simultaneously in the same patient and includes: mental sharpness and acuteness, intense sensitivity to pain both mental and physical, sleeplessness, inquietude, nervous excitability; anxiety, fear, fright, anger, rage, fury, propensity to jump out of bed and roll on the floor, mirth, hilarity, liveliness, diarrhoea, delirium, hallucinations, spasms, convulsions, increased sensitivity to sound so that they can hear the distant sound of bells from a steeple or even the proverbial sound of a fly crawling up the wall.

An increased sensitivity can result in insomnia (sleeplessness) and narcolepsy (inability to sleep despite fatigue) with intermittent brief periods of sleep which are light, restless or easily disturbed. Hearing becomes so acute that they seem able to detect even the faint sounds of insects’ movements or the crow of a cock from a great far off distance. They are sleepy but unable to sleep. The sound of their own breathing disturbs them. The bed seems so hot that they must jump out of it and roll on the floor to cool down. Breathing becomes very heavy and deep (stertorous) and may even become irregular or even momentarily stop (sleep apnea).

They also have convulsions in which the body is held in an abnormal posture with the head drawn back (opisthotonos) It usually involves rigidity and severe arching of the back, with the head thrown backward. If a person with opisthotonos lies on his or her back, only the back of the head and the heels would touch the supporting surface.

Any of these sleep conditions can pose a true disruption and even a danger to an individual’s life and mental state. Used homeopathically, Opium often offers the relief that other solutions fail to provide. Taking Opium in this capacity allows sleep to be regulated and continuous so that it is neither interrupted nor unusual in its occurrence.

In addition to increased sensitivity opium can benefit those sleep deprived individuals where insomnia is caused by a major life disruption, fear or trauma.

Finally, for those who can’t seem to get to sleep or stay asleep, Opium offers an answer for a peaceful slumber. It can help so called light sleepers who remain wide awake for a long time after going to bed with acuteness of all sensations, hearing especially – the least unusual noise will awaken, and it is a long time before they can go to sleep again.

8. Bibliography

Classical Homeopathy by Dr. Margery Blackie
Prisma – The Arcana of Materia Medica by Frans Vermulen
Materia Medica of Homoeopathic Medicines by S.R. Phatak