Abstract
Background
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.
Methods
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.
Results
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.
Discussion
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.
Keywords
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Article info
Publication history
Published online: April 07, 2022
Accepted:
April 5,
2022
Received in revised form:
April 2,
2022
Received:
February 22,
2022
Identification
Copyright
© 2022 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
