Ipsilateral forced head and eye turning at the end of the generalized tonic-clonic phase of versive seizures

Wyllie, Elaine MD
Lüders, Hans MD, PhD
Morris, Harold H. MD
Lesser, Ronald P. MD
Dinner, Dudley S. MD
Goldstick, Lawrence MD

Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH.

Address correspondence and reprint requests to Dr. Wyllie, Department of Neurology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106.

Accepted for publication January 13, 1986.

Neurology 36(9):p 1212-1217, September 1986.

Article abstract

We studied 61 spontaneous seizures in 27 epileptic patients with simultaneous EEC and video recording. Each seizure had an initial forced turning (versive) head and eye movement contralateral to the EEG location of seizure onset. Twelve of the 27 secondarily generalized versive seizures also had ipsilateral head and eye version at the end of the generalized convulsion. Initial contraversion and late ipsiversion both appeared to result from ictal activation of frontal contraversive areas in the hemisphere that, at the time, was predominantly involved in the seizure discharge. During initial contraversion, ictal activation was predominant in the hemisphere of seizure onset; during late ipsiversion, in the hemisphere involved by secondary generalization. Late version, unlike initial version, is frequently ipsilateral and cannot be assumed to indicate seizure onset in the contralateral hemisphere.