SIGNIFICANCE OF HEAD TURN SEQUENCES IN TEMPORAL-LOBE ONSET SEIZURES

We studied head turning in 239 complex partial seizures with or withou t generalization, in 32 patients with unilateral temporal lobe epileps y. Head turns occurred in 73% of seizures that did not evolve to focal jerking or secondary generalization, and in all 41 seizures that seco ndarily generalized. In seizures without focal jerking or secondary ge neralization the most common pattern was that of single head turns (70 %) which were ipsilateral to the focus in 94%. The next most common pa ttern was that of two or more head turns, with the first two turns in the same direction (19%), always ipsilateral to the focus, In seizures with secondary generalization, the most common sequence was that of t wo head turns contralateral to each other (59% of seizures), The first was always ipsilateral to the focus, associated with dystonic posturi ng in 96%, and was not tonic in character. The second was always contr alateral, was tonic in character, and was still present within five se conds of secondary generalization or focal jerking. Our results sugges t different patterns and sequences of head turning in temporal lobe co mplex partial seizures without, and those with focal jerking or second ary generalization. Some sequences have powerful lateralizing value th at can complement other lateralizing features.