Neonatal seizures are usually an acute manifestation of disturbance of the developing brain and are very common in the first weeks of life (1-5 per 1000 live births). The outcome of neonates with neonatal seizures has changed in recent years due to improved prenatal care, better obstetrical care and intensive neonatal care. However, it still remains an important contributor to future neurological complications. Based on this, immediate and aggressive anticonvulsant therapy seems reasonable, but standardized approaches to the treatment of neonatal seizures remain undeveloped. There is a paucity of strong clinical evidence on the efficiency of anticonvulsants and their effects on neurodevelopment. In particular, few studies address the issues related to the use of antiepileptic drugs (AEDs), as first-line and second-line agents. Nevertheless, despite concern about diagnosis, most physicians choose to treat neonates who have seizures, most commonly with either phenobarbital or phenytoin as first line drug. In the current clinical query we have tried to address the unresolved issue of first line drug treatment for neonatal seizures, which would benefit the clinician in taking an evidence based decision for the treatment of neonatal seizures. Development of a safe and effective treatment strategy for neonates with seizures remains an important priority for future research.

Key words: Seizures; Neonate; Phenytoin; Phenobarbitone.