Clinical Reasoning: A 6-week-old infant with migrating focal seizures

A 6-week-old previously healthy boy who had been born at term presented with episodes of right facial twitching lasting 30 seconds, occurring multiple times daily. Neurologic examination was normal. Maternal pregnancy and birth history was unremarkable. Family history was negative for seizures. Initial EEG monitoring showed multifocal spikes (figure, A and B) and multifocal seizures, some that were clinically associated with facial twitching. He was treated with phenobarbital.