Lateralizing value of early head turning and ictal dystonia in temporal lobe seizures: a video-EEG study

To investigate early head turning, we retrospectively studied videotapes of 262 seizures from 82 patients who were seizure free after temporal lobecto my. Early head movements were arbitrarily classified into non-tonic turning , tonic taming, and absence of turning. Among the 222 seizures which showed early head turning, 168 (75.7%) had non-tonic turning and 54 (24.3%) had t onic turning. The direction of the first head turning was ipsilateral to th e epileptogenic foci in 132 (78.6%) seizures with non-tonic turning and in 35 (64.8%) seizures showing tonic head turning. The proportion of seizures with turning towards the ipsilateral side in the presence of tonic and non- tonic head turning were significantly different (P=0.04). Seventy-four seiz ures (28.2%) evolved to secondary generalization, more frequently found in seizures with early head turning (P=0.0015) and especially those showing to nic turning (P <0.0001). The direction of head turning immediately precedin g secondary generalization was contralateral to the lesion side in 53 seizu res (82.8%). Dystonic upper limb posturing occurred in 86 seizures (32.8%), exclusively contralateral to the seizure focus, whereas 65 (75.6%) were as sociated with initial head turning ipsilateral to the focus. In summary, te mporal lobe seizures with tonic head turning tends to secondarily generaliz e and the direction of head turning before secondarily generalized was cont ralateral to the seizure foci. Earlier in the seizures the direction of non -tonic head turning tends to be towards the epileptogenic hemisphere. In ad dition, dystonic posturing of the extremities is a significant lateralizing sign to the contralateral hemisphere in temporal lobe seizures. (C) 2001 B EA Trading Ltd.