cqvip:Objective: To identify lateralizing features during seizures in infants and as sess their reliability. Methods Infants were included if they had video EEG mon itoring at our institution, and were seizure free for at least 12 months after epilepsy surgery. Lateralizing signs and seizure symptomatology were classified based on blinded video review. Results We analyzed 100 seizures from 19 infants (1 to 32, mean 13 months of age) (1 to 14 seizures per patient). Potential later alizing signs were seen in 58 seizures from 12 infants, including unilateral clo nic jerking (8 patients); forced, sustained tonic version of the eyes to one sid e (7 patients); predominantly unilateral infantile spasms (5 patients); unilater al tonic stiffening of an arm and leg (2 patients); nystagmus (2 patients) and p ostictal hemiparesis (1 patient). Except for tonic eye version, each of the sign s was contralateral to the hemisphere of seizure onsetin all but one patient wh o had predominantly ipsilateral spasms and clonic arm activity. Tonic eye versio n was contralateral in 3 patients, ipsilateral in 1 patient, and toward either s ide in different seizures in 3 patients. Conclusion Reliable lateralizing signs included focal clonic activity and predominantly unilateral spasms. Focal tonic activity, nystagmus and postictal hemiparesis were also consistently contralater al but were observed only in few patients. Tonic eye version was unreliable and could not beused to lateralizeseizure onset. The sequence of eye and head version evolvi ng to generalized tonic clonic convulsions was not seen in this age group.
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