The significance of head and eye turning in seizures

We evaluated the history of ictal versive movement in determining the site of the seizure focus. The focus was in the hemisphere opposite the direction of head or eye turning in more than 90% of patients. Ipsiversive movements were more likely to occur with temporal foci and were never found with occipital foci. Maintenance of awareness during versive movements indicated a contralateral focus in 100% and origin from the frontal lobe in 93%; a temporal focus was more likely if awareness was not maintained. Ictal versive movements, if unequivocal, consistent, and forced, are of reliable lateralizing and localizing value.