ASSOCIATION OF IPSILATERAL HEAD TURNING AND DYSTONIA IN TEMPORAL-LOBESEIZURES

We evaluated head turning in 239 complex partial seizures (CPS) with o r without generalization in 32 patients with unilateral temporal lobe epilepsy (TLE). Head turns occurred in 187 seizures of 31 patients, mo re than once in 71 seizures. The first head turn was ipsilateral to th e focus in 162 seizures (87%), with a mean latency of 22 s, as compare d with 83 s for contralateral first head turns, Concomitant dystonic p osturing of the arm occurred with 71% of all ipsilateral head turns an d with 16% of all contralateral head turns. The mean difference in abs olute latency between the first head turn and concomitant dystonic pos turing was 6 s. Examination of all instances of concomitant head turni ng and dystonic posturing (160) showed them to be contralateral to eac h other in 154 (96%). Furthermore, the dystonia was contralateral and head turning was ipsilateral to the focus in 149 (93%). Forty-one seiz ures secondarily generalized, with transitional tonic head deviation c ontralateral to the focus in 35. Early head turning suggests an ipsila teral temporal seizure focus, particularly when associated with contra lateral dystonic posturing. Similar mechanisms may account for both. T onic head deviation preceding secondary generalization probably has a different mechanism.