Ipsiversive ictal eye and head deviation in a child with cerebral dysgenesis

Deviation of the head or eyes at the onset of a seizure usually suggests that the seizure focus is located in the contralateral hemisphere. We describe an infant with extensive cerebral dysgenesis in whom left frontal ictal discharges on EEG were consistently correlated with leftward deviation of the head and eyes. Resection of the left frontal lobe eliminated the focal ictal discharges and versive head and eye movements. Thus, in an abnormally formed immature brain, ictal head and eye movements are not necessarily associated with contralateral ictal discharges, and such ictal discharges can be falsely localizing.