We studied the anatomical correlates of reflex hot water epilepsy (HWE) using 
multimodality investigations viz. magnetic resonance imaging (MRI), 
electroencephalography (EEG), and single photon emission computed tomography 
(SPECT). Five men (mean age: 27.0 ΁ 5.8 years) with HWE were subjected to MRI of 
brain, video-EEG studies, and SPECT scan. These were correlated with phenotypic 
presentations. Seizures could be precipitated in three patients with pouring of 
hot water over the head and semiology of seizures was suggestive of temporal 
lobe epilepsy. Ictal SPECT showed hyperperfusion in: left medial temporal - one, 
left lateral temporal - one, and right parietal - one. Interictal SPECT was 
normal in all five patients and did not help in localization. MRI and interictal 
EEG was normal in all the patients. The clinical and SPECT studies suggested 
temporal lobe as the seizure onset zone in some of the patients with HWE.