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Title: Ictal Dystonia and Non Versive Early Head Turns – Clinical Significance
Objective: Evaluation of the laterizing value and subtype analysis of unilateral dystonic posturing (UDP) and non versive early head turns (NVEHT) in temporal lobe epilepsy.
Background: While UDP is a reliable ictal laterizing sign, there is conflicting evidence on the significance of NVEHT. The relevance of different subtypes of these clinical signs remains unclear. Prior research indicates that laterizing semiology predicts favourable seizure outcome after epilepsy surgery.
Design/Methods: Retrospective analysis of 311 seizures in 126 patients with unilateral temporal lobe epilepsy verified by comprehensive preoperative evaluation.
Results: UDP was observed in 16% of seizures and was contralateral to the epileptogenic focus in 95% (p<0.001). A subtype-analysis demonstrated that only UDP with evident forced and rotatory elements was of laterizing significance. NVEHT occurred in 39% of seizures and were ipsilateral in 67% (p<0.05). Ipsilateral and contralateral NVEHT had a mean duration of 24.1s and 12.8s respectively (p<0.05), the mean latencies were 20.3s and 27.4s. The positive predictive value of NVEHT was higher in seizures without generalization than in secondary generalized seizures (70% vs. 47%; p=0.074). NVEHT were associated with UDP in 60% of patients and were ipsilateral in 73% of these.
In comparison, UDP was observed in only 2% of seizures in a group of 17 patients (47 seizures) without verified temporal lobe focus.
Conclusions: UDP is a reliable lateralizing sign in temporal lobe seizures but only when forced and rotatory components are apparent. NVEHT are ipsilateral to seizure onset in approximately two-thirds of cases, a higher positive predictive value is associated with longer duration, absence of secondary generalization and concomitant UDP.