Neonatal Seizure Classification

The majority of seizures in neonates are provoked by an acute illness or brain insult, and are therefore acute provoked seizures (also called acute symptomatic seizures) and not due to epilepsy. Neonates do not have generalized onset seizures, only focal onset seizures occur. Unlike at other ages, seizures are classified by the predominant clinical feature seen during the seizure, which may not be the first feature. It is not possible to confidently define levels of awareness or the first feature at seizure onset in neonates, and the predominant seizure feature has more value for understanding aetiology.

Neonatal seizure types

• Focal clonic seizure
• Focal automatism seizure
• Focal tonic seizure
• Focal myoclonic seizure
• Focal epileptic spasms

• Focal autonomic seizure
• Focal behavioural arrest seizure

• A sequential seizure is a seizure typically seen in the neonate, where there is a sequence of features during the seizure, but no predominant feature. There may be changing lateralisation within the seizure. For example, a sequential seizure might have a sequence of tonic, clonic, myoclonic and then autonomic features.