Ictal head turning in frontal and temporal lobe epilepsy *Jan Re ´ mi, *Philipp Wagner, *Rebecca O’Dwyer, yJoa ˜ o P. Silva Cunha, *Christian Vollmar, *Isabella Krotofil and *Soheyl Noachtar *Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany; and yIEETA/Department of Electronics, Telecommunications and Informatics, University of Aveiro, Aveiro, Portugal SUMMARY Purpose: 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 unilat- eral FLE where head turning occurred in the seizure evo- lution. 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 analy- ses were performed. Key Findings: All of the TLE seizures had both contralat- eral and ipsilateral head turning, whereas all FLE had con- tralateral 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 signifi- cantly 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 ipsi- lateral 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. Significance: Quantitative analysis of head turning dem- onstrates significant differences between patients with FLE and TLE. These differences likely represent differ- ences in spread of epileptic activity. This information may be useful in the seizure evaluation of patients considered for resective epilepsy surgery. KEYWORDS: Ictal head turning, Frontal eye field, Seizure semiology, Temporal lobe epilepsy, Frontal lobe epilepsy. Versive movements of the eyes and head during epileptic seizures have been subject to controversy. Some authors had found good lateralizing value when the movement was classified as unnatural and forced (Wyllie et al., 1986a), or if head turning was accompanied by dystonic posturing of the upper limb (Fakhoury & Abou Khalil, 1995; Bleasel et al., 1997). Other studies could not support this finding (Robillard et al., 1983; Ochs et al., 1984). Some of the ambiguity of studies on head turning was attributed to the poor interobserver reliability of qualitative semiologic anal- ysis (Jayakar et al., 1992). This ambiguity was resolved in patients with temporal lobe epilepsy (TLE) by using quanti- tative analysis of ictal head movements. It was shown that the sequence of head turning had to be recognized to achieve lateralizing value, with ipsilateral preceding contra- lateral head turning (O’Dwyer et al., 2007). Ictal versive head movement is thought to reflect spread of epileptic activity to the frontal eye field (FEF) (Manford et al., 1996) correlating with results from electrical stimula- tion (Godoy et al., 1990). In different epilepsy syndromes, this spread of epileptic activity may occur sooner or later and after ictal activation of other cortical areas and subse- quent spread to the FEF (Lieb et al., 1991; Gotz-Trabert et al., 2008). We, therefore, investigated in this present study whether ictal head turning is different in seizures aris- ing from the frontal lobe as compared to seizures arising from the temporal lobe. Methods Terminology The terms ‘‘head version’’ and ‘‘head turning’’ have been defined previously as relating to the contralateral head movement (‘‘head version’’) and any head turning movement (‘‘head turning’’) (Wyllie et al., 1986a,b). It is Accepted March 7, 2011; Early View publication May 31, 2011. Address correspondence to Prof. Dr. Soheyl Noachtar, Epilepsy Center, Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. E-mail: noa@med.uni-muenchen.de Wiley Periodicals, Inc. ª 2011 International League Against Epilepsy Epilepsia, 52(8):1447–1451, 2011 doi: 10.1111/j.1528-1167.2011.03076.x FULL-LENGTH ORIGINAL RESEARCH 1447