**Neonatal seizures are closely linked to cerebral palsy (CP), with substantial evidence indicating that seizures occurring in the neonatal period often reflect underlying brain injury or dysfunction that can lead to CP and other neurodevelopmental disorders.**
Neonatal seizures are seizures that occur within the first 28 days of life and are often a sign of acute brain injury or dysfunction. These seizures are not only a symptom but also a marker of potential long-term neurological consequences. One of the most significant outcomes associated with neonatal seizures is cerebral palsy, a group of permanent movement and posture disorders caused by non-progressive disturbances in the developing brain.
**The connection between neonatal seizures and cerebral palsy is primarily due to the underlying brain injury that causes the seizures.** Common causes of neonatal seizures include hypoxic-ischemic encephalopathy (HIE), infections, intracranial hemorrhage, stroke, metabolic disorders, and brain malformations. Among these, HIE—brain injury caused by oxygen deprivation around the time of birth—is a leading cause of both neonatal seizures and subsequent cerebral palsy[1][4].
Studies have shown that children who survive acute provoked neonatal seizures are at increased risk for neurodevelopmental consequences, including epilepsy and cerebral palsy[1][2]. For example, a cohort study of children who experienced neonatal seizures found that nearly half had hypoxic-ischemic encephalopathy as the cause of their seizures, and many developed long-term neurological impairments such as CP[1]. This indicates that the seizures themselves are often a symptom of brain injury severe enough to cause cerebral palsy.
**Epilepsy and cerebral palsy frequently co-occur, with epilepsy present in approximately 25% to 45% of children with CP[6].** This high prevalence suggests that the brain abnormalities causing CP also predispose to seizures. Neonatal seizures can be an early manifestation of this brain dysfunction. The presence of seizures in the neonatal period often signals a higher risk of developing epilepsy later in childhood, which is common in children with CP[6].
**The severity and type of brain injury influence the risk and type of cerebral palsy that develops.** For instance, spastic cerebral palsy, the most common form, is often linked to perinatal brain injury such as HIE. Children with spastic CP frequently have accompanying epilepsy, which can be traced back to neonatal seizures or early brain insults[3]. The quality of life in children with CP is also affected by the presence of epilepsy and sleep disorders, which are more common in those with a history of neonatal seizures[3].
**Advances in neonatal care, including therapeutic hypothermia (cooling), have improved outcomes for infants with HIE and neonatal seizures, reducing the incidence and severity of cerebral palsy.** Therapeutic hypothermia involves cooling the infant’s body or head shortly after birth to reduce brain injury. Clinical trials such as the “Cool Cap” and TOBY trials demonstrated that hypothermia treatment can decrease death and severe disability, including cerebral palsy, in neonates with moderate to severe encephalopathy and abnormal brain activity on EEG[5]. However, the benefit is more pronounced in infants with less severe EEG abnormalities, indicating that early intervention is critical.
**Diagnostic tools like amplitude-integrated EEG (aEEG) and video EEG monitoring are essential for detecting neonatal seizures and assessing brain function.** These tools help identify infants at risk for cerebral palsy and guide treatment decisions[4]. Early detection and management of neonatal seizures can potentially mitigate brain injury and improve neurodevelopmental outcomes.
**In summary, neonatal seizures are strongly tied to cerebral palsy because they often indicate significant brain injury during a critical period of brain development.** The underlying causes of neonatal seizures, especially hypoxic-ischemic encephalopathy, are major contributors to the development of CP. The presenc
