title: Ictal head turning in frontal and temporal lobe epilepsy.
abstract: OBJECTIVE
  To quantitatively evaluate the difference of ictal head turning movements between patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE).
  
  
  METHODS
  We investigated 38 seizures of 31 patients with unilateral TLE and 22 seizures of 14 patients with unilateral FLE where head turning occurred in the seizure evolution. The head movements were defined as ipsilateral or contralateral in reference to the lateralization of the patient's focal epilepsy syndrome. Head movements were quantified by either referencing the head position with manually placed markers or by automatic detection of infrared marked reference points. The time of onset, duration, and angular speed of the head movements were computed, and interindividual and intraindividual analyses were performed.
  
  
  RESULTS
  All of the TLE seizures had both contralateral and ipsilateral head turning, whereas all FLE had contralateral head turning; only 6 of 22 seizures were associated with ipsilateral head turning. Ipsilateral head turning always preceded contralateral head turning in both TLE and FLE. The head turning occurred significantly sooner after clinical seizure onset in FLE than in TLE patients (ipsilateral 0.5 vs. 16.0 s, contralateral: 4.5 vs. 21.3 s; p < 0.001). Furthermore, the duration of head turning was shorter in FLE for contralateral head turning (4.1 s) than in TLE (contralateral 6.0 s, p < 0.01); the ipsilateral head turning in the two groups did not differ (3.0 vs. 2.9 s) in duration. The angular speed of head turning did not differ for ipsilateral and for contralateral head turning in FLE and TLE.
  
  
  CONCLUSIONS
  Quantitative analysis of head turning demonstrates significant differences between patients with FLE and TLE. These differences likely represent differences in spread of epileptic activity. This information may be useful in the seizure evaluation of patients considered for resective epilepsy surgery.
authors.affiliation: Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Rémi
authors.forename: Philipp
authors.initials: P
authors.lastname: Wagner
authors.forename: Rebecca
authors.initials: R
authors.lastname: O'Dwyer
authors.forename: João P
authors.initials: JP
authors.lastname: Silva Cunha
authors.forename: Christian
authors.initials: C
authors.lastname: Vollmar
authors.forename: Isabella
authors.initials: I
authors.lastname: Krotofil
authors.forename: Soheyl
authors.initials: S
authors.lastname: Noachtar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017034:Epilepsy, Frontal Lobe / Q000503:physiopathology*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology*; D005260:Female; D019416:Head Movements; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures; D055815:Young Adult