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Ictal head deviation

Lateralizing significance of the pattern of head movement

Comprehensive Epilepsy Center, Miami Children's Hospital, Miami, FL.

To resolve the controversy surrounding the lateralizing value of ictal head deviation, we analyzed head-turning movements in relation to the actions of the two divisions of the sternocleidomastoid muscle. In 12 (75%) of 16 patients with surgically confirmed lateralized seizure foci, the face rotated upward and contraversive to the hemisphere of seizure origin, consistent with activation of the ipsilateral sternomastoid muscle. One patient showed a sustained, downward ipsiversive head tilt consistent with the action of the ipsilateral cleidomastoid muscle, and three patients had a combined ipsiversive head tilt and contraversive face rotation. No patient exhibited ipsiversive upward face rotation or contraversive head tilting, as would be expected if the contralateral sternocleidomastoid were activated. Our findings indicate that hemispheric seizure foci activate one or both divisions of the ipsilateral sternocleidomastoid muscle. Accurate lateralization of the seizure focus is possible only when ictal head deviation is assessed in the context of the different actions of the sternomastoid and cleidomastoid muscle divisions.

Address correspondence and reprint requests to Dr. P. Jayakar, Comprehensive Epilepsy Center, Department of Neuroscience, Miami Children's Hospital, 6125 SW 31st Street, Miami, FL 33155.

Presented in part at the 44th annual meeting of the American Academy of Neurology, San Diego, CA, May 1992.

Received November 25, 1991. Accepted for publication in final form March 10, 1992.

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