The etiology of the seizure is critical in deciding the outcome and prognosis. Recent evidence suggests that neonatal seizures impair normal brain development. In infants with transient or metabolic disorders that can be corrected, the outcome is usually favorable. In infants with CNS infections, hypoxic-ischemic encephalopathy, or brain malformations, the outcome is not as favorable. The type of seizure can also dictate outcome. In one study, pure clonic seizures without facial involvement in term infants suggested favorable outcome, whereas generalized myoclonic seizures in preterm infants were associated with mortality. Prognosis is usually better for term infants than preterm infants. In one study of 34,615 infants, 90 were noted to have seizures by strict clinical classification. Of the 90 children, 27% of survivors had epilepsy, 25% had cerebral palsy, 20% had mental retardation, and 27% had a learning disorder. Poor prognosis was associated with severe encephalopathy, complicated IVH, infections in preterm neonates, abnormal interictal EEG, cerebral dysgenesis, and the use of multiple drugs to treat the seizures. Attempts have been made to develop a scoring system to predict outcomes since the 1980s. Recently, by scoring for birthweight, Apgar score at 1 minute, neurologic examination at seizure onset, head ultrasound, efficacy of anticonvulsant therapy, and presence of neonatal status epilepticus, a composite score was computed. The score ranged from 0 to 12 and a cutoff score of ≥4 provided greatest sensitivity and specificity for predicting neurodevelopmental outcome at 2 years. A simple scoring system used numerically scored and visually graded (independently) analysis of the EEG background. Higher score correlated with increasing incidence of mortality, neurodevelopmental impairment, cerebral palsy, vision and hearing impairment, and epilepsy.