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Vertical and horizontal epileptic gaze deviation and nystagmus

Epilepsy Monitoring Unit, Department of Neurology, Francis Scott Key Medical Center, and the Epilepsy Monitoring Unit, Baltimore, MD. (Dr. Kaplan)
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD. (Dr. Lesser)

Periods of epileptic nystagmus consisting of rightward eye deviation and right-beating nystagmus, alternating with upward eye deviation and upbeating nystagmus, occurred in a comatose patient with a left hemisphere subdural hematoma and seizures. The periods of upbeating nystagmus were associated with symmetric, low-voltage 3 to 4 Hz bifrontal spikes. Rightward eye deviation and right-beating nystagmus occurred with diffuse, predominantly left hemispheric 4 to 6 Hz sharp waves. No eye movements occurred in the absence of spike and wave activity. These correlations agree with current concepts of the cortical control of saccadic eye movements in monkeys studied by electrical stimulation.

Address correspondence and reprint requests to Dr. Kaplan, Department of Neurology, Francis Scott Key Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224.

Received December 20, 1988. Accepted for publication in final form April 17, 1989.

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