Bathing-Related Reflex Epilepsy in a Young Adult: First Reported Case from Palestine

Abstract Bathing-related reflex epilepsy (BRE) is an uncommon type of reflex epilepsy characterized by seizures that are reliably induced by contact with water during bathing or showering. In contrast to the more prevalent hot-water epilepsy (HWE), which is temperature-dependent, typically focal, and often benign, bathing-related epilepsy (BRE) can manifest with water of any temperature, display generalized features, and demonstrate resistance to pharmacological treatment. A 22-year old male is reported with a five-year history of recurrent seizures predominantly occurring during bathing. Episodes were characterized by brief generalized tonic movements, eye rolling, frothy oral secretions, and transient loss of consciousness, succeeded by a prolonged postictal state lasting up to 30 minutes. Seizures occurred four to five times per month, primarily triggered by running water, and continued despite treatment with Lamotrigine, Carbamazepine, and Levetiracetam. Continuous 24-hour EEG monitoring recorded a habitual seizure triggered by water contact, revealing generalized high-amplitude rhythmic spike-and-wave discharges at 9 Hz, thereby confirming the diagnosis of BRE. This case underscores the diagnostic significance of ictal EEG and the necessity of differentiating between BRE and HWE. The identification of non-temperature-dependent triggers, the application of lifestyle modifications, and the evaluation of underlying genetic factors, especially SYN1 mutations, are critical for effective management and enhancement of long-term outcomes in patients with reflex epilepsies.