My son is 4 and has been having focal seizures for a year. We were switched from tegretol to valproate about two months ago with good results initially. His seizures have returned and so his dose was increased. In the last two days, he has started to have twitching/quivering of his mouth mostly when eating, but also when trying to talk. Today, I even noticed it in one hand. I think it is improved once he gets his meds (which may explain why it seems to be most pronounced at breakfast and dinner). I think it might be pre-seizure activity as it did resolve for half a day after he had a short seizure involving his mouth. Now it is back and almost worse as it is in his hand too. Has anyone else ever seen this as pre-seizure activity? Would pre-seizure activity be bilateral when his seizures are unilateral. Can anyone think of any other cause? Can it be a strange manifestation of migraines (which he also gets). We are doing his levels tomorrow so I guess we will see if he is somehow subtherapeutic in spite of his dose increase.