Contralateral head leading turning accompanied by ipsilateral eye staring in a patient with seizure onset from posterior inferior temporal sulcus , a SEEG case report

The epileptic eye and head movements during epileptic seizures may be much more complicated than people originally understood, which can be ipsilateral or contralateral to the electroencephalography focus. Here, we describe a male patient with drug resistant focal seizures associated with a directional separation between head and eye movement before evolving into generalized tonic-clonic seizure. His contralateral head leading turning showed forced, sustained, and unnatural features companied by ipsilateral eye staring. Stereoeletroencephalography monitoring was performed, and 4 habitual seizures were recorded over 5 days. Three seizures showed left head leading turning and generalized tonic-clonic seizure, and only one showed dizziness and ringing in the ears. All the seizures showed that the ictal onset contacts were located in the posterior inferior temporal sulcus which borders on the anterolateral part of medial superior temporal area. The patient underwent a resection including temporooccipital region, and the histopathology showed focal cortical dysplasia type Ic. He has been seizure free for two years after operation. The scores of the intelligence and memory quotient improved half year after operation.