A 58-year-old woman developed bilateral facial myokymia in 1978, persisting for the next 23 years and associated with high titers of voltage-gated K(+) channel (VGKC) antibodies. Brain imaging failed to show a pontine lesion. The clinical facial myokymia and electromyographic doublets and multiplets (43 to 250 Hz) were milder and more restricted than those seen in generalized neuromyotonic disorders with VGKC antibodies. This case and another reported recently represent a focal VGKC antibody syndrome.