Ictal head deviation: Lateralizing significance of the pattern of head movement

P. Jayakar, M. Duchowny, T. Resnick, L. Alvarez

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1989-1992
Number of pages4
JournalNeurology
Volume42
Issue number10
StatePublished - Oct 1992

ASJC Scopus subject areas

  • Clinical Neurology

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    Jayakar, P., Duchowny, M., Resnick, T., & Alvarez, L. (1992). Ictal head deviation: Lateralizing significance of the pattern of head movement. Neurology, 42(10), 1989-1992.