title: Ipsilateral head deviation in frontal lobe seizures.
abstract: OBJECTIVE
  The lateralizing value of ictal head deviation (HD) in frontal lobe epilepsy (FLE) is a matter of debate. Although FLE is typically associated with tonic or clonic HD contralateral to seizure onset, ipsilateral HD has been noted in numerous reports. Whether both types of HD can be distinguished according to their clinical patterns has not yet been specifically investigated.
  
  
  METHODS
  We studied the clinical pattern and time of occurrence of HD of 129 seizures in 13 consecutive patients, who underwent successful surgery for FLE, including 12 investigated with an intracerebral stereotactic EEG procedure.
  
  
  RESULTS
  Ictal HD was ipsilateral to the epileptogenic zone (EZ) in four (30%) patients and 27 (20.9%) seizures and contralateral in five (38%) patients and 15 (11.6%) seizures. Ipsilateral HD was rarely tonic and never associated with clonic manifestation. Contralateral HD was always tonic, unnatural, and associated with hemifacial clonic movements in 86% of seizures. Ipsilateral HD occurred earlier than contralateral HD (p < 0.03), with a mean delay of 1 +/- 2 s after the first detectable ictal sign, as compared with a delay of 17 +/- 11 s for contralateral HD. Moreover, ipsilateral HD always occurred before contralateral HD when both signs coexisted in the same seizure. Our patients with ipsilateral HD demonstrated either an anterior or dorsolateral frontal EZ.
  
  
  CONCLUSIONS
  Ipsilateral HD is a common ictal sign during FLE and can be distinguished from contralateral HD by its time of occurrence at or immediately after seizure onset and its lacking association with clonic movements.
authors.affiliation: Department of Functional Neurology and Epileptology, Neurological Hospital, Lyon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Rheims
authors.forename: Genevieve
authors.initials: G
authors.lastname: Demarquay
authors.forename: Jean
authors.initials: J
authors.lastname: Isnard
authors.forename: Marc
authors.initials: M
authors.lastname: Guenot
authors.forename: Catherine
authors.initials: C
authors.lastname: Fischer
authors.forename: Marc
authors.initials: M
authors.lastname: Sindou
authors.forename: François
authors.initials: F
authors.lastname: Mauguiere
authors.forename: Philippe
authors.initials: P
authors.lastname: Ryvlin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000706:statistics & numerical data; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006257:Head / Q000503:physiopathology*; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011187:Posture / Q000502:physiology*; D013238:Stereotaxic Techniques; D013997:Time Factors