Epileptic nystagmus is a relatively rare clinical seizure presentation. The direction is usually determined by the fast component of the eye movement. We retrospectively reviewed 1838 consecutive patients admitted to the Epilepsy Monitoring Unit at Cleveland Clinic and identified 9 patients (0.5%) with epileptic nystagmus. Only two of them were adults. The direction of the nystagmus was contralateral to the epileptogenic zone in all patients. In contrast, eye version was seen ipsiversive to the epileptic nystagmus in four of the six patients in whom both signs were observed. Epileptic nystagmus is a helpful lateralizing sign, particularly in pediatric patients.