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Ipsilateral head deviation in frontal lobe seizures.

Sylvain Rheims1, Genevieve Demarquay, Jean Isnard

  • 1Department of Functional Neurology and Epileptology, Neurological Hospital, Lyon, France.

Epilepsia
|November 24, 2005
PubMed
Summary

This study examined the direction and timing of head deviation during seizures in patients with frontal lobe epilepsy. Researchers found that head deviation can be either ipsilateral or contralateral to the seizure onset zone. Ipsilateral head deviation occurs earlier than contralateral head deviation and is not associated with clonic movements. The study suggests that these two types of head deviation can be distinguished by their timing and clinical features. The findings indicate that ipsilateral head deviation is a common ictal sign in frontal lobe seizures and may be lateralizing to the epileptogenic zone. The study also found that ipsilateral head deviation is not associated with clonic movements, unlike contralateral head deviation. The results support the idea that ipsilateral head deviation can be used to infer seizure onset zone location. The authors propose that ipsilateral head deviation is a reliable clinical sign in frontal lobe seizures.

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Area of Science:

  • Neurological disorders diagnosis
  • Epilepsy clinical research
  • Frontal lobe seizure localization

Background:

Frontal lobe seizures often produce head deviation, but the direction of this movement is debated as a lateralizing sign. Prior research has shown that head deviation is typically contralateral to seizure onset in frontal lobe epilepsy. However, some studies have reported ipsilateral head deviation in these cases. No prior work had resolved how to distinguish these two types of head deviation based on clinical patterns. This gap motivated researchers to investigate whether ipsilateral and contralateral head deviation can be differentiated by their timing and clinical features. It was already known that head deviation is a common ictal sign in frontal lobe seizures. That uncertainty drove this study to explore the relationship between head deviation and seizure onset. No prior work had specifically examined the temporal sequence of ipsilateral and contralateral head deviation in frontal lobe epilepsy. This lack of clarity prompted a closer look at the clinical patterns and timing of these movements.

Purpose Of The Study:

Keywords:
frontal lobe epilepsyictal head deviationseizure localizationclinical seizure patterns

Frequently Asked Questions

Ipsilateral head deviation occurs earlier than contralateral head deviation and is not associated with clonic movements.

Intracerebral stereotactic EEG was used to investigate the epileptogenic zone in 12 of the 13 patients.

Timing helps distinguish ipsilateral from contralateral head deviation, with ipsilateral occurring at or immediately after seizure onset.

Contralateral head deviation is often associated with hemifacial clonic movements, while ipsilateral is not.

Related Experiment Videos

The aim of this study was to examine the clinical patterns and timing of ictal head deviation in frontal lobe seizures. Researchers focused on whether ipsilateral and contralateral head deviation could be distinguished by their temporal sequence and clinical features. The study sought to determine if ipsilateral head deviation occurs earlier than contralateral head deviation and if it is associated with specific seizure onset zones. The motivation for this research came from the lack of clarity in distinguishing these two types of head deviation. The study aimed to clarify the lateralizing value of head deviation in frontal lobe epilepsy. The researchers wanted to investigate whether ipsilateral head deviation is a reliable indicator of seizure onset zone location. The study also aimed to explore the relationship between head deviation and seizure semiology. This research aimed to provide a clearer understanding of the clinical significance of head deviation in frontal lobe seizures.

Main Methods:

The study analyzed 129 seizures in 13 patients who underwent successful surgery for frontal lobe epilepsy. Twelve of these patients had intracerebral stereotactic EEG investigations. Researchers recorded the clinical pattern and timing of head deviation during each seizure. The direction of head deviation was classified as ipsilateral or contralateral to the epileptogenic zone. The timing of head deviation was measured relative to the first detectable ictal sign. The study compared the frequency and characteristics of ipsilateral and contralateral head deviation. Researchers examined whether ipsilateral head deviation occurred before or after contralateral head deviation in the same seizure. The study also assessed the association between head deviation and specific seizure semiological features.

Main Results:

Ipsilateral head deviation occurred in 30% of patients and 20.9% of seizures. Contralateral head deviation was observed in 38% of patients and 11.6% of seizures. Ipsilateral head deviation was rarely tonic and never associated with clonic movements. Contralateral head deviation was always tonic and often accompanied by hemifacial clonic movements in 86% of seizures. Ipsilateral head deviation occurred earlier than contralateral head deviation, with a mean delay of 1 +/- 2 seconds after seizure onset. Contralateral head deviation had a mean delay of 17 +/- 11 seconds after seizure onset. When both types of head deviation occurred in the same seizure, ipsilateral deviation always preceded contralateral deviation. Patients with ipsilateral head deviation had either anterior or dorsolateral frontal epileptogenic zones.

Conclusions:

The authors propose that ipsilateral head deviation is a common ictal sign in frontal lobe epilepsy. This study suggests that ipsilateral and contralateral head deviation can be distinguished by their timing and clinical features. The findings indicate that ipsilateral head deviation occurs earlier than contralateral head deviation. The study shows that ipsilateral head deviation is not associated with clonic movements, unlike contralateral head deviation. The researchers suggest that ipsilateral head deviation may occur at or immediately after seizure onset. The authors propose that ipsilateral head deviation is lateralizing to the epileptogenic zone. The study supports the idea that ipsilateral head deviation is a reliable clinical sign in frontal lobe seizures. The authors conclude that ipsilateral head deviation can be used to infer seizure onset zone location.

The study analyzed 129 seizures in 13 patients with frontal lobe epilepsy.

The authors suggest that ipsilateral head deviation is lateralizing to the epileptogenic zone.