PURPOSE: To evaluate the role of intermittent prophylaxis with clobazam in the 
management of HWE in a long-term prospective study.
MATERIAL AND METHODS: Two hundred and sixty patients [M:F - 194:66] with HWE 
were recruited. Patients were divided into: (a) 'HWE alone' (n=198) - received 
intermittent clobazam prophylaxis, 1-1½h prior to hot water head bath (group A); 
(b) 62 patients (20.4%) with 'HWE with spontaneous seizures were treated with 
continuous AEDs along with intermittent clobazam therapy (group B).
RESULTS: Patients (n=198) in group A was followed for mean of 17.6 ± 10.6 months 
(range: 3-57). One hundred and forty seven patients (74.2%) had excellent 
response with complete seizure freedom with clobazam therapy while 12 (6.1%) had 
>75% reduction in seizure frequency. Remaining 39 (19.7%) required additional 
standard AED along with clobazam and 18 patients among them developed 
spontaneous/unprovoked seizure at follow up of 6.7 ± 4.1 months. Forty five 
patients in group B were seizure free while on continuous AEDs.
CONCLUSIONS: Intermittent clobazam prophylaxis prior to head water bath might be 
a preferred mode of treatment of pure HWE. Additional AEDs are required if they 
have associated non-reflex unprovoked seizure.