A 41-year-old female pilot for a major airline presented with subacute worsening of brief events of involuntary stereotyped motor movements. The episodes began 3 years ago and until recently were sporadic. They consisted of an abrupt onset of left arm posturing with elevation toward her face and "smacking her lips". At the same time she reported that her left face would draw upward associated with a transient inability to verbally respond to questions. The episodes were several seconds in duration and occurred three times daily on average. She reported that they were so brief that they did not impact her cognition or impair her overall ability to function. Worsening began following a long airplane flight where she had been sleep-deprived due to a busy and difficult work schedule causing them to occur several times an hour. Her general and neurological examination was normal. An MRI was obtained and was found to be normal. A serum drug screen and laboratory was unrevealing. An EEG was subsequently obtained and captured an episode (Fig. 21.1).
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