Introduction: Neonatal-onset epilepsies are rare but distinct group with significant neurodevelopmental morbidity. The data on etiology and outcomes is scarce.

Methods: Cross-sectional observational study of infants with epilepsy onset within 2 months of life.

Results: Thirty-two infants included over 12 months period: Females were 18 (56%), mean age at onset of seizures was 14.7 days (1-54 days). Encephalopathy was present at onset of seizures in 13 (40.6%). Consanguinity and family history of epilepsy was present in 17 (53%) and 13 (40.6%) respectively. The commonest seizure was focal clonic (69%), and multiple seizure types seen in 12 (37%). Of 21 infants with complete work-up (biochemical/metabolic/imaging/ genetic), 18 had confirmed diagnosis-yield of 86%: Seven had structural abnormalities, three had metabolic disorders. Eleven of 22 infants with suspected genetic etiology underwent genetic testing, of which 8 were confirmed.

At 6 months follow-up, 15 of 22 infants (68%) had either died (3) or had severe developmental delay (12), while 3 had mild delay and 4 were normal. Average age at seizure control in infants with mild delay or normal development was 5.6 months (2-14 months). Infants required mean of 4 drugs for seizure control (2-8), corticosteroids in 6 and ketogenic diet in 3. Infants with delayed seizure control (p=0.01) and epileptic encephalopathy on EEG (p=0.044) had poor outcome (death or severe disability). Epileptic spasms, polymorphic seizures, age at seizure onset, MRI abnormalities, number of drugs required were not associated with short-term outcome.

Conclusion: Neonatal-onset epilepsies have high diagnostic yield, and significant neuro-developmental morbidity.