Neonatal seizures

Elissa G Yozawitz MD (Dr. Yozawitz of the Albert Einstein College of Medicine has no relevant financial relationships to disclose.)
Emma Laureta MD (Dr. Laureta of Hofstra North Shore-LIJ School of Medicine has no relevant financial relationships to disclose.)
Solomon L Moshé MD (

Dr. Moshé of Albert Einstein College of Medicine received honorariums from UCB as a member of a data and safety monitoring board and an honorarium and travel reimbursement from Malinckrodt for an advisory board meeting.

Jerome Engel Jr MD PhD, editor. (Dr. Engel of the David Geffen School of Medicine at the University of California, Los Angeles, has no relevant financial relationships to disclose.)
Originally released October 18, 1993; last updated May 10, 2018; expires May 10, 2021

This article includes discussion of neonatal seizures, acute reactive seizures, electroclinical seizures in the newborn period, electrographic seizures in the newborn period, neonatal convulsions, newborn seizures, seizure patterns in newborn infants, and seizures in newborn babies. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


Neonatal seizures are seizures occurring within the first 28 days in a full-term infant and extending to the 44 completed weeks gestational age in the preterm infant. The neonatal period is the most vulnerable of all periods of life for development of epileptic seizures. Most neonatal seizures are acute reactive (structural/metabolic) seizures, the most common cause being hypoxic-ischemic encephalopathy, stroke, or infection in term babies. Neonatal seizures appear most often early after birth, usually during the first 1 to 2 days of life, especially when associated with an acute provoking factor such as hypoxia-ischemia during labor. The etiology requires immediate diagnosis and treatment, and the seizures typically resolve once the underlying trigger subsides. Neonatal seizures may be associated with adverse neurodevelopmental sequelae or death, with possible long-term motor and cognitive problems, or with post-neonatal epilepsy.

Key points


• The neonatal brain is more prone to seizures than the mature brain.


• Most neonatal seizures are acute reactive seizures, the most common cause in term infants being hypoxic-ischemic encephalopathy, stroke, or infection.


• The most commonly used current classification of neonatal seizures divides the seizures into clonic, tonic, myoclonic, and motor automatisms/subtle.


• About 60% to 70% of neonatal seizures are subclinical and would not be recognized without continuous EEG monitoring.


• Phenobarbital is a first-line treatment for neonatal seizures. Fosphenytoin/phenytoin can also be used or added for additional benefit, as well as midazolam. Additional medications that may be used as an off-label medication include levetiracetam or topiramate. There is a need for new treatments that are age specific.

Historical note and terminology

More than 50 years ago, seizures in the neonatal period were known for their strong relation to permanent handicap in the survivors (Burke 1954). Our understanding of neonatal seizures has evolved over the years, and the methods of recording seizures by EEG have become more refined (digital EEG and continuous video-EEG monitoring). Conventional EEG is the current gold standard to detect neonatal seizures (Shellhaas 2015; Pisani and Pavlidis 2018).

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