This 67-year-old man had twitching of his left face for about 20 years. Over the last 2 years, he experienced increased frequency and severity of jerking, which affected his ability to teach accounting, his profession. He underwent resection of a large right frontal meningioma 15 years ago, with reintervention due to regrowth a year later. He had been on antiseizure prophylaxis with phenytoin first and lamotrigine later. Only one seizure
developed when he was rapidly discontinued from phenytoin. He had no tinnitus, vertigo, or disequilibrium, and no previous facial palsy or facial trauma. He had an extensive set of normal investigations, including brain magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) and electroencephalography (EEG).