Neonatal seizures, as distinguished from nonconvulsive abnormal movements, are a significant problem in neonatal intensive care units. Clinical diagnosis without EEG confirmation is difficult. By virtue of brain metabolic and peripheral physiologic effects, seizures may damage the immature brain. The approach to neonatal seizures should be systematic and directed at establishing the primary etiology. On the basis of tradition, phenobarbital is currently the drug of first choice in the treatment of neonatal seizures. A significant number of neonates with seizures have poor outcomes, and both duration of seizure activity and numbers of anticonvulsants required in treatment predict the outcome.