Focal epilepsy presenting as a bath-induced paroxysmal event/breath-holding attack

Abstract

Bath-induced paroxysmal events in infants and children can be triggered by various etiologies, including cardiological, neurological, and metabolic causes. It is important to ascertain the underlying cause for such events as this significantly affects the child's management and prognosis. We present the case of a 19-month-old boy who presented with recurrent episodes of apnea, cyanosis, and reduced level of consciousness in response to bathing. Through detailed history and investigation, the diagnosis of water reflex epilepsy was made. Treatment with carbamazepine and adjustment of the bathing technique have prevented further episodes from occurring, and the child's growth and development are progressing normally.ConclusionWater reflex epilepsy can mimic a range of other conditions, and a high index of suspicion is required to establish the diagnosis. Children with water reflex epilepsy can achieve a good quality of life with modified bathing and appropriate antiepileptic medication.

Bathing epilepsy: a video case report

“…In our case, clinical features and EEG ictal findings were consistent with bathing epilepsy. The differential diagnosis of bathing epilepsy is complex and a comprehensive workup, including a video-EEG recording of the seizures during bathing, is necessary to exclude non-epileptic events or other epilepsy syndromes [2,3]. The prognosis of bathing epilepsy is usually benign.…”

A Review of the Therapeutic Targeting of SCN9A and Nav1.7 for Pain Relief in Current Human Clinical Trials

“… 43 Children with this condition may develop constipation in an attempt to prevent pain attack. 44 The attacks of pain that occur with these young children may be also associated with seizures, 45 slowed heartbeat 2 and apnea. 46 As the children get older, the pain location seems to change, switching from the lower portion of the body to affecting mostly the face and the head with the pain being focused on the eyes and the jaws.…”

Bath-induced paroxysmal events — Notes on a case report

“…This contradicts the findings of our very careful review [2] , which found only four conditions triggered by bathing in infants, these being bathing epilepsy — by far the commonest [2] , [3] , [4] , [5] , alternating hemiplegia of childhood [6] , hyperekplexia, and paroxysmal extreme pain disorder [2] . Stutchfield and Loh [1] stated that reflex anoxic seizures (reflex asystolic syncope), cyanotic breath-holding spells (prolonged expiratory apnea), and cardiac syncope from long QT syndrome might be triggered by bathing in infancy, but to my knowledge, no such reports have been published.…”

“…I was interested to read the case report of bathing epilepsy published by Stutchfield and Loh [1] and wish to comment on several misleading statements and factual errors. As the authors would know, we have published a comprehensive review of bath-induced events [2] .…”

“…Stutchfield and Loh [1] begin their Abstract by writing that “Bath-induced events in infants and children can be triggered by various etiologies, including cardiological, neurological, and metabolic causes.” This statement reflects the general message of the paper and its conclusion that “There is a wide differential diagnosis for reduced conscious level triggered by bathing” [1] . This contradicts the findings of our very careful review [2] , which found only four conditions triggered by bathing in infants, these being bathing epilepsy — by far the commonest [2] , [3] , [4] , [5] , alternating hemiplegia of childhood [6] , hyperekplexia, and paroxysmal extreme pain disorder [2] .…”