Research Article| Volume 98, P44-50, May 2022

Download started.


A descriptive study of eye and head movements in versive seizures



      Versive seizures, consisting of forced, involuntary, sustained and unnatural turning of eyes and head toward one side, lateralize to the hemisphere contralateral to the direction of the eye and head turn. The characteristics of eye and head movements in version have been rarely and incompletely studied in spontaneous epileptic seizures as opposed to direct cortical stimulation studies.


      We performed a single center retrospective analysis of a cohort of 28 patients with 43 seizures, who had been admitted to the adult epilepsy monitoring unit at University Hospitals Cleveland Medical Center between January 2009 and August 2020. We only included patients with clear, high-resolution seizure videos and interpretable EEG.


      The eye movements were conjugate and contralateral to the hemisphere of seizure onset in 100% of the focal-onset seizures. The eye movements were saccadic in 89.3% with a predominant vector in oblique upward direction in 86.8% of the seizures. Head deviation was present in 100% of the seizures and the eyes and head deviated in the same direction in 97.6% of the seizures. In addition to deviation along the horizontal meridian, there was a vertical component to the head deviation as well, as evidenced by movement of the chin upward along the vertical axis in 93% of the seizures, thus indicating strong activation of the sternocleidomastoid muscle ipsilateral to the hemisphere of seizure onset. Concomitant facial motor activity ipsilateral to the direction of version was seen in 93% of the seizures. The most common pattern was a clonic superimposed on tonic facial contraction.


      Version remains a reliable and highly lateralizing sign. The majority of the eye movements during version occur in a saccadic fashion rather than one smooth movement, mostly in an oblique upward direction. Head deviation is very closely associated with eye deviation, thus indicating a common symptomatogenic zone for both, which is most likely the frontal eye field. A high concurrence of ipsilateral facial motor activity with version is likely because of close proximity of the frontal eye field to the face area in the primary motor cortex.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Seizure - European Journal of Epilepsy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Penfield W.
        • Kristiansen K.
        Epileptic seizure patterns.
        Charles C. Thomas, 1951
        • Penfield W.
        • Jasper H.
        Epilepsy and the functional anatomy of the human brain.
        1st ed. Little, Brown, Boston1954
        • Wyllie E.
        • Lüders H.
        • Morris H.H.
        • Lesser R.P.
        • Dinner D.S.
        The lateralizing significance of versive head and eye movements during epileptic seizures.
        Neurology. 1986; 36: 606-611
        • Gastaut H.
        The epilepsies: electro-clinical correlations.
        Charles C. Thomas, 1954
        • Rasmussen T.
        • Penfield W.
        Movement of head and eyes from stimulation of human frontal cortex.
        Res Publ Assoc Res Nerv Ment Dis. 1948; 27: 346-361
        • Godoy J.
        • Lüders H.
        • Dinner D.S.
        • Morris H.H.
        • Wyllie E.
        Versive eye movements elicited by cortical stimulation of the human brain.
        Neurology. 1990; 40: 296-299
        • Blanke O.
        • Spinelli L.
        • Thut G.
        • et al.
        Location of the human frontal eye field as defined by electrical cortical stimulation: anatomical, functional and electrophysiological characteristics.
        Neuroreport. 2000; 11: 1907-1913
        • Blanke O.
        • Seeck M.
        Direction of saccadic and smooth eye movements induced by electrical stimulation of the human frontal eye field: effect of orbital position.
        Exp Brain Res. 2003; 150: 174-183
        • Baysal-Kirac L.
        • Rémi J.
        • Loesch A.M.
        • Hartl E.
        • Vollmar C.
        • Noachtar S.
        Eye movements differ between ictal ipsilateral and contralateral head turning.
        Epilepsy Res. 2015; 114: 73-77
        • Munari C.
        • Bonis A.
        • Kochen S.
        • Gybels J.
        • Hitchcock E.R.
        • Ostertag C.
        • Rossi G.F.
        • Siegfried J.
        • Szikla G.
        • et al.
        Eye movements and occipital seizures in man.
        Advances in stereotactic and functional neurosurgery 6. acta neurochirurgica (Supplementum). Springer, Vienna1984: 47-52 (33)
        • Chee M.W.
        • Kotagal P.
        • Van Ness P.C.
        • Gragg L.
        • Murphy D.
        • Lüders H.O.
        Lateralizing signs in intractable partial epilepsy: blinded multiple-observer analysis.
        Neurology. 1993; 43: 2519-2525
        • Kernan J.C.
        • Devinsky O.
        • Luciano D.J.
        • Vazquez B.
        • Perrine K.
        Lateralizing significance of head and eye deviation in secondary generalized tonic-clonic seizures.
        Neurology. 1993; 43: 1308-1310
        • Marashly A.
        • Ewida A.
        • Agarwal R.
        • Younes K.
        • Lüders H.O.
        Ictal motor sequences: lateralization and localization values.
        Epilepsia. 2016; 57: 369-375
        • Thurtell M.J.
        • Mohamed A.
        • Lüders H.O.
        • Leigh R.J.
        Evidence for three-dimensional cortical control of gaze from epileptic patients.
        J Neurol Neurosurg Psychiatry. 2009; 80: 683-685
        • Bleasel A.
        • Kotagal P.
        • Kankirawatana P.
        • Rybicki L.
        Lateralizing value and semiology of ictal limb posturing and version in temporal lobe and extratemporal epilepsy.
        Epilepsia. 1997; 38: 168-174
        • Bruce C.J.
        • Goldberg M.E.
        • Bushnell M.C.
        • Stanton G.B.
        Primate frontal eye fields. II. Physiological and anatomical correlates of electrically evoked eye movements.
        J Neurophysiol. 1985; 54: 714-734
        • Leigh R.J.
        • Zee D.S.
        The neurology of eye movements.
        Oxford University Press, 2015
        • Kaiboriboon K.
        • Lüders H.O.
        • Miller J.P.
        • Leigh R.J.
        Upward gaze and head deviation with frontal eye field stimulation.
        Epileptic Disord. 2012; 14 (Mar): 64-68
        • Shinoda Y.
        • Sugiuchi Y.
        • Izawa Y.
        • Hata Y.
        Long descending motor tract axons and their control of neck and axial muscles.
        Prog Brain Res. 2006; 151: 527-563
        • Ochs R.
        • Gloor P.
        • Quesney F.
        • Ives J.
        • Olivier A.
        Does head-turning during a seizure have lateralizing or localizing significance?.
        Neurology. 1984; 34: 884-890