Seizures in the neonatal period are different from seizures later in childhood. They often arise from acute brain or systemic illness, can have subtle or no visible clinical signs, and require EEG-based diagnosis and neonatal-specific treatment pathways.
Why newborn seizures are different
The newborn brain is still developing, and neonatal seizures have distinctive causes, EEG features and clinical presentations.
Many events that look like seizures in a newborn are not epileptic, while some genuine neonatal seizures are electrographic-only and cannot be diagnosed reliably by observation alone.
Common causes
Important causes include hypoxic-ischaemic brain injury, stroke, intracranial haemorrhage, infection, metabolic disturbance, structural brain abnormalities and genetic or metabolic epilepsies.
The likely causes vary with gestational age, timing after birth, clinical history and associated neurological findings.
EEG is central
Continuous or prolonged EEG monitoring is often needed because neonatal seizures can be subtle and because antiseizure treatment can suppress visible movements before electrographic seizure activity has stopped.
This clinical-electrographic dissociation is one reason neonatal seizure care differs from seizure care in older children.
Neonatal seizures do not always mean neonatal-onset epilepsy
Many neonatal seizures are acute symptomatic seizures caused by a temporary or acute brain insult.
When acute provoked seizures have stopped and there is no evidence of neonatal-onset epilepsy, the ILAE neonatal treatment guideline supports stopping antiseizure medication before discharge in appropriate cases rather than automatically continuing long-term treatment.
Treatment guidance
The 2023 ILAE guideline recommends phenobarbital as first-line treatment for most neonatal seizures, with exceptions when a channelopathy is strongly suspected.
Second-line options depend on the clinical situation. Treatment decisions in newborns require specialist neonatal and neurological care.
Vitamin B6-dependent epilepsies
Persistent neonatal seizures can occasionally reflect pyridoxine- or pyridoxal-5-phosphate-dependent epilepsy.
In selected neonates with treatment-resistant seizures and compatible features, specialist teams may use a monitored vitamin B6 trial while investigating genetic and metabolic causes.
Long-term follow-up
Outcome depends much more on the underlying brain disorder than on the mere fact that a neonatal seizure occurred.
Some infants recover without later epilepsy, while others develop epilepsy, motor disability, cognitive or developmental difficulties and need long-term multidisciplinary follow-up.
Related reading
Sources and further reading
- ILAE treatment guideline for seizures in the neonate — 2023
- ILAE neonatal seizure guideline overview — 2024
- ILAE Commission on Pediatrics — neonatal seizure reports
Evidence checked: September 2026.