Hot water epilepsy with cerebral lesion: a report of five cases with cranial MRI findings.

Hot water epilepsy (HWE) is included in the reflex epilepsies. Although, in general, not common, HWE is concentrated in certain regions of the world. Different bathing habits and genetic factors may be responsible for the high incidence of HWE in these regions. However, the exact pathogenesis of HWE is not known. The facts that complex partial seizures are the most common clinical presentation and EEG recordings show an epileptic focus in the temporal lobe suggested the presence of a structural lesion in the temporal lobe. To our knowledge, however, there were no demonstrable structural changes on MRI and CT scans except in a few case reports. Here, we describe an additional five cases of HWE having an intracranial pathology, for example, hippocampal sclerosis, dysplasia, and a huge cystic lesion. We believe that investigations with new detailed neuroimaging techniques, in addition to experimental and clinical studies, might help us to understand the mechanism of this reflex epilepsy.

Comparison of classifications of seizures: a preliminary study with 28 participants and 48 seizures.

PURPOSE: Our aim was to compare three available seizure classifications (SCs), namely, the international classification of epileptic seizures published in 1981 (ICES; Epilepsia 1981;22:489-50); the semiological seizure classification (SSC) by H. Luders, J. Acharya, C. Baumgartner, et al. (Epilepsia 1998;39:1006-13; Acta Neurol Scand 1999;99:137-41); and the proposal of a new diagnostic scheme for seizures (PDSS) by J. Engel, Jr. (Epilepsia 2001;42:796-803) published in 2001. The three SCs were compared with respect to diagnostic success rates, usefulness, and consistency by a large group of neurologists in this preliminary study. METHODS: After a training period, 28 blindfed participants with different levels of experience with epilepsy classified videos or written descriptions of 48 randomly selected seizures according to the three SCs. Definite diagnoses of the seizures were established based on all clinical, ictal/interictal EEG, and MRI data. All the participants answered a questionnaire concerning their preferences for SCs after the study. RESULTS: The overall diagnostic success rates were 81.4% for ICES, 80.5% for PDSS, and 87.5%, for SSC. Various parameters concerning experience with epilepsy affected success rates positively, without reaching statistical significance, whereas experience with epilepsy surgery appeared to be a parameter significantly affecting the success rate in all SCs. In reliability analysis, Cronbach's alpha was 0.94 for ICES, 0.88 for PDSS, and 0.70 for SSC, all showing good agreement in the group. Nineteen reviewers chose SSC, eight chose ICES, and one chose PDSS as their preference in the questionnaire, completed after the end of the study. CONCLUSION: The results of this preliminary study demonstrate that with proper training, physicians treating epilepsy patients can handle new SCs, and emphasize the need for revision of the current classification.