The most common clinical presentation of neonatal seizures is?

• A. Subtle
• B. Tonic-Clonic movements
• C. Apnea alone
• D. Ocular movements

Answer: (A)

Neonatal seizures most commonly present with subtle, nonconvulsive signs rather than dramatic convulsions. In newborns, the immature brain often expresses seizures as small, easily overlooked events—eye movements or deviations, eyelid flutter, lip or tongue movements, chewing-like motions, or brief autonomic changes such as apnea or color/fluid shifts. Because many seizures in this age are electrographic-only or have very brief or focal motor components, they can be mistaken for jitteriness or normal newborn behaviors unless careful observation and, often, EEG monitoring are used. While tonic-clonic activity can occur, it is far less common in neonates, making subtle presentations the typical pattern.