Seizure characteristics in 32 neonates were studied prospectively using prolonged video/EEG recording at the Prince of Wales Children’s Hospital, Sydney, Australia. Seizures were generally frequent with limited electrographic spread. Of 1420 seizures recorded, 85% had no clinical manifestations. Clinical observations underestimated electrographic seizures in 54% of neonates. The use of portable EEG machines with only 4 electrodes underestimated seizures in 19 neonates and failed to recognize seizures present in 2. Seizures were generally recorded in both hemispheres, but restricted spread of the seizure discharge necessitated full electrode placements for identification. Some neonates had long interictal periods, and recordings >60 min were often required for diagnosis. 
COMMENT. This study confirms that clinical features are unreliable markers of seizures in neonates, especially in those receiving antiepileptic drugs. Prolonged video/EEG monitoring is essential for confirmation of seizure control.