title: Ictal body turning in focal epilepsy.
abstract: Despite the explanations of many lateralization findings, body turning in focal epilepsy has been rarely investigated. One of the aims of this study was to evaluate the role of ictal body turning in the lateralization of focal epilepsies. The records of 263 patients with focal epilepsy (temporal lobe epilepsy (TLE), n=178; extratemporal lobe epilepsy (ETLE), n=85) who underwent prolonged video-EEG monitoring during presurgical epilepsy evaluation were reviewed. Preoperative findings (TLE, n=16; ETLE, n=6) and postoperative outcomes (TLE, n=7) of patients with focal epilepsy with ictal body turning were assessed. For the evaluation of ictal body turning, two definitions were proposed. Nonversive body turning (NVBT) was used to denote at least a 90° nonforced (without tonic or clonic component) rotation of the upper (shoulder) and lower (hip) parts of the body around the body axis for a minimum of 3s. Versive body turning (VBT) was used to denote at least a 90° forced (with tonic or clonic component) rotation of the upper (shoulder) and lower (hip) parts of the body around the body axis for a minimum of 3s. Nonversive body turning was observed in 6% (n=11) of patients with TLE and 2% (n=2) of patients with ETLE. For VBT, these ratios were 5% (n=8) and 7% (n=6) for patients with TLE and ETLE, respectively. Nonversive body turning was frequently oriented to the same side as the epileptogenic zone (EZ) in TLE and ETLE seizures (76% and 80%, respectively). If the amount of NVBT was greater than 180°, then it was 80% to the same side in TLE seizures. Versive body turning was observed in 86% of the TLE seizures, and 55% of the ETLE seizures were found to be contralateral to the EZ. When present with head turning, NVBT ipsilateral to the EZ and VBT contralateral to the EZ were more valuable for lateralization. In TLE seizures, a significant correlation was found between the head turning and body turning onsets and durations. Our study demonstrated that ictal body turning is a rarely observed but reliable lateralization finding in TLE and ETLE seizures, which also probably has the same pathophysiological mechanism as head turning in TLE seizures.
authors.affiliation: Gazi University Faculty of Medicine, Department of Neurology, Ankara, Turkey. Electronic address: dr_metin_mercan@hotmail.com.
authors.forename: Metin
authors.initials: M
authors.lastname: Mercan
authors.affiliation: Gazi University Faculty of Medicine, Department of Neurology, Ankara, Turkey.
authors.forename: İrem
authors.initials: İ
authors.lastname: Yıldırım
authors.affiliation: Gazi University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey.
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Akdemir
authors.affiliation: Gazi University Faculty of Medicine, Department of Neurology, Ankara, Turkey.
authors.forename: Erhan
authors.initials: E
authors.lastname: Bilir
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology* / Q000601:surgery; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000503:physiopathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D012399:Rotation; D012640:Seizures / Q000503:physiopathology* / Q000601:surgery; D014741:Video Recording; D055815:Young Adult
keywords: Body turning; Head turning; Temporal lobe epilepsy