TY - JOUR
T1 - Ictal head deviation
T2 - Lateralizing significance of the pattern of head movement
AU - Jayakar, P.
AU - Duchowny, M.
AU - Resnick, T.
AU - Alvarez, L.
PY - 1992/10
Y1 - 1992/10
N2 - 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 hemi-sphere of seizure origin, consistent with activation of the ipsilateral sternomastoid muscle. One patient showed a sus-tained, 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 activat-ed. Our findings indicate that hemispheric seizure foci activate one or both divisions of the ipsilateral sternocleidomas-toid 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.
AB - 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 hemi-sphere of seizure origin, consistent with activation of the ipsilateral sternomastoid muscle. One patient showed a sus-tained, 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 activat-ed. Our findings indicate that hemispheric seizure foci activate one or both divisions of the ipsilateral sternocleidomas-toid 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.
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U2 - 10.1212/wnl.42.10.1989
DO - 10.1212/wnl.42.10.1989
M3 - Article
C2 - 1407581
AN - SCOPUS:0026800705
VL - 42
SP - 1989
EP - 1992
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 10
ER -