Abstracts

Rationale: Ictal head turning has value as a lateralising sign if careful attention is paid to its character and sequence. The contralateral versive head turning (1) has been distinguished from ipsilateral non-versive head turning early in automotor seizures (2) and with bilateral asymmetric tonic seizures (BATS) (3). We have observed a distinct pattern of head turning in occipital- parietal lobe seizures with potential localising value. Methods: We reviewed ictal head turning in surgical cases of frontal lobe (FLE) and occipital- parietal lobe (OPLE) epilepsies. Seizures of 51 patients with FLE and 16 with OPLE investigated between 2002-2012 were reviewed, to identify all patients with ictal head turning. Contralateral or ipsilateral ictal head turning was characterised as versive; forced, sustained & unnatural positioning, with clonic or tonic facio-brachial movements and non-versive; unforced, interrupted or seemingly voluntary movement. Results: We reviewed 111 seizures of 22 patients with ictal head turning. Head turning occurred in 13/51 FLE patients; 5/13 had non-versive ipsilateral or contralateral head turning of 30- 45 degrees with BATS and 8/13 patients had contralateral versive head turning followed by generalised tonic clonic seizures (GTCS). The mean duration of the versive head turning was 17 sec (range 10-40 sec ). In the OPLE group, 6/16 patients had versive head turning not distinguishable from that seen in the FLE patients with a mean duration of 13 sec (6-32 sec). Three patients had seizures characterized by isolated, prolonged, smooth or interrupted head and eye turning in an inferior lateral direction without facio brachial involvement. The onset of the eye movement preceded the head turn. The mean duration was 94.8 sec (66-203 sec). Conclusions: We found a distinctive contralateral ictal head turning in OPLE not seen in our cohort of FLE. While a potential localising sign, this is relatively uncommon in OPLE. Contralateral versive head turning with facio brachial clonus has lateralising but not localising value, having the same features in both FLE and OPLE. Contralateral versive head turning seen in OPLE is likely to represent anterior propagation of OPLE seizures. References 1. Wyllie E et al. The lateralizing significance of versive head and eye movements during epileptic seizures. Neurology 1986 May, 36 (5): 606-11 2. O Dwyer et al. lateralizing significance of quantitative analysis of head movements before secondary generalization of seizures of patients with temporal lobe epilepsy. Epilepsia 2007;48 (3):524-530. 3. Bleasel A, Luders H. Tonic Seizure, in Epileptic seizures: pathophysiology and clinical semiology. Chapter 34, p389-411, 2000. Churchill Livingstone, Philadelphia