Association of ipsilateral head turning and dystonia in temporal lobe seizures

We evaluated head turning in 239 complex partial seizures (CPS) with or without generalization in 32 patients with unilateral temporal lobe epilepsy (TLE). Head turns occurred in 187 seizures of 31 patients, more than once in 71 seizures. The first head turn was ipsilateral to the focus in 162 seizures (87%), with a mean latency of 22 s, as compared with 83 s for contralateral first head turns. Concomitant dystonic posturing of the arm occurred with 71% of all ipsilateral head turns and with 16% of all contralateral head turns. The mean difference in absolute latency between the first head turn and concomitant dystonic posturing was 6 s. Examination of all instances of concomitant head turning and dystonic posturing (160) showed them to be contralateral to each other in 154 (96%). Furthermore, the dystonia was contralateral and head turning was ipsilateral to the focus in 149 (93%). Forty-one seizures secondarily generalized, with transitional tonic head deviation contralateral to the focus in 35. Early head turning suggests an ipsilateral temporal seizures focus, particularly when associated with contralateral dystonic posturing. Similar mechanisms may account for both. Tonic head deviation preceding secondary generalization probably has a different mechanism.