One page summary: Neonatal seizures

In two sentences

A seizure is a burst of abnormal electrical activity in the brain. In newborns it usually does not look like the shaking most people picture. It can look like lip smacking, bicycling legs, eyes deviating to one side, or a pause in breathing. ¹

Most newborn seizures produce no movement at all. They can only be seen on an EEG. That is why a baby suspected of seizures needs brain monitoring rather than observation alone. ¹

The numbers, with their sources

• When they happen. Seizures are more common in the newborn period than at any other time of life ²
• What they look like. Subtle signs are the most common: eye deviation, lip smacking, bicycling or pedaling movements, and apnea. Generalized shaking is uncommon in newborns ¹
• Why EEG is required. A large share of newborn seizures are electrical only, with no visible movement, and cannot be diagnosed by watching ¹
• The most common cause. Hypoxic-ischemic encephalopathy is the leading cause of seizures in the newborn period ¹
• Causes that are treatable in minutes. Low blood sugar and low calcium are checked immediately, because treating them stops the seizures and prevents further injury ³
• What the cause predicts. Outcome after newborn seizures is driven mainly by the underlying cause and the extent of brain injury, not by the seizures alone ²

What to do this week

1. Ask whether EEG confirmed the seizures, and whether there were electrical seizures without visible movement.
2. Ask what the EEG background looked like, which is the part that predicts most.
3. Ask what caused them, and what has been ruled out.
4. Ask what the plan is for stopping medicine.
5. Ask whether glucose, calcium and infection were all checked.
6. Ask whether an MRI is planned and when.
7. Learn what a seizure would look like at home, and keep your phone ready to film.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the neonatologist

• Was this confirmed on EEG, and was it full EEG or aEEG?
• Were there electrical seizures with no movement?
• What was checked for a cause: glucose, calcium, infection, imaging?
• What is the medicine, and what is the plan for stopping it?

For the neurologist

• What did the EEG background show between seizures?
• What did the MRI show?
• Should we do genetic or metabolic testing?
• What is the risk of epilepsy later, and what would we watch for?
• What does a seizure look like in a 6-month-old, so I know what I am looking for?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Neonatal seizures

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.