Significance of head turn sequences in temporal lobe onset seizures

We studied head turning in 239 complex partial seizures with or without generalization, in 32 patients with unilateral temporal lobe epilepsy. Head turns occurred in 73% of seizures that did not evolve to focal jerking or secondary generalization, and in all 41 seizures that secondarily generalized. In seizures without focal jerking or secondary generalization the most common pattern was that of single head turns (70%) which were ipsilateral to the focus in 94%. The next most common pattern was that of two or more head turns, with the first two turns in the same direction (19%), always ipsilateral to the focus. In seizures with secondary generalization, the most common sequence was that of two head turns contralateral to each other (59% of seizures). The first was always ipsilateral to the focus, associated with dystonic posturing in 96%, and was not tonic in character. The second was always contralateral, was tonic in character, and was still present within five seconds of secondary generalization or focal jerking. Our results suggest different patterns and sequences of head turning temporal lobe complex partial seizures without, and those with focal jerking or secondary generalization. Some sequences have powerful lateralizing value that can complement other lateralizing features.