Epilepsy, Seizures and Water Safety

Urgent first

If someone has a seizure in water, get their face out of the water safely and call emergency services. In the United States call 911. Never leave a person who has had a seizure in a bath or tub alone. This page is information only, not medical advice, and does not replace guidance from the person's own epilepsy team.

Why water needs extra care

Epilepsy Action (a UK charity) says that if you have seizures it is important to take extra care when bathing, because there could be a risk of drowning during a seizure [1]. A 2022 systematic review of 83 studies on adult drowning found epilepsy increased relative risk of drowning by 3.8 to 82 times, and suggested supervised bathing or showering as prevention [2]. The wide range reflects different studies and settings. Evidence label: observational evidence of harm; specific risk size uncertain.

What the studies of deaths found

• Alberta, 1981 to 1990. Of 482 drowning deaths, 25 (5%) were considered directly related to seizures. Fifteen of the 25 occurred in an unsupervised bath, one in a shower, one in a jacuzzi, and two in public pools, with others in rivers, lakes and private pools [3]. The authors concluded people with epilepsy should be encouraged to take showers while sitting instead of baths, and that others in the house who are not directly supervising do not protect against drowning [3].
• UK children, 1988 to 1989. Children with epilepsy had a higher incidence of submersion accidents, but no child in supervised swimming drowned. Two children died in the bath [4].

These are older, small studies of deaths, so they cannot say how common drowning is among all people with epilepsy.

Practical suggestions from health bodies

The NHS says to have showers instead of baths if you can [5]. Epilepsy Action suggests, among other things [1]:

• Use a shower instead of a bath if possible, because the water runs away.
• Tell someone when you are bathing or showering, and ask them to stay nearby or within hearing.
• Use "engaged/vacant" signs rather than locks.
• If you do take a bath, keep the water shallow and have someone with you in the bathroom if possible, since there is still a risk of drowning even in shallow water.
• In the shower, sit down if possible and check the temperature controls work well.

These are charity suggestions, not individual instructions; your epilepsy team may advise differently.

Hot tubs, saunas and warm baths

The Alberta study includes one jacuzzi death among the 25 [3]. Whether heat itself changes seizure risk is not addressed in the sources we read. Proper evidence not found; we checked NHS, Epilepsy Action and PubMed searches for epilepsy with bathing and drowning. Note that the NHS lists seizure among heatstroke symptoms [6]. Heat illness details are on heat illness, dehydration and overheating.

Alcohol, tiredness and medicines

The NHS says too much alcohol can increase seizure risk and not to miss epilepsy medicine doses or change treatment without advice [5]. In the Alberta study, 19 of 23 people on anticonvulsants had undetectable or subtherapeutic drug levels at autopsy [3]. Never change medicines because of anything here. See alcohol, drugs and hydrotherapy.

Pools and open water

Kemp and Sibert concluded that children with epilepsy can swim with a friend in a lifeguard-supervised pool, with individual advice for those with poorly controlled seizures [4]. The NHS says to think about safety when swimming or doing sports [5]. See pool safety for exercise and therapy and drowning risk in baths, hot tubs and cold water.

Who to ask first

Anyone with epilepsy, or new fainting or blackouts, should ask their clinician before starting any water activity. Questions and conditions to mention are in preparing for hydrotherapy.

What we could not read

The Epilepsy Foundation (US) page returned an access error, so US charity guidance is not summarized. The Epilepsy Action page date was not shown in what we read.