Quantitative Analysis of Ictal Head Movements in Temporal Lobe Epilepsy

Purpose: To quantitatively evaluate the lateralizing significance
of ictal head movements of patients with temporal lobe epilepsy
(TLE). Methods: We investigated EEG-video recorded seizures of
patients with TLE, in which the camera position was perpendicular
to the head facing the camera in an upright position and bilateral
head movement was recorded. Thirty-eight seizures (31 patients)
with head movement in both directions were investigated.
Ipsilateral and contralateral head movement were defined according
to ictal EEG. Head movements were quantified by selecting the
movement of the nose in relation to a defined point on the thorax
(25/s) in a defined plane facing the camera. The duration of the
head version was determined independently of the camera angle. The
angle, duration and angular speed of the head movements were
computed and inter- and intrasubject analyses were performed
(Wilcoxon rank sum). Results: Ipsilateral movement always preceded
contralateral movement. The positive predictive value (PPV) was
100% for movement in both directions. The duration of contralateral
head version was significantly longer than ipsilateral head
movement (6.4s ± 4.1s vs. 3.9s ± 3.1s, p