<p>Epileptic seizures are among the most common neurological manifestations in the neonatal period. A&#xa0;distinction is made between acute symptomatic (provoked) and unprovoked neonatal seizures: the former arise from brain injuries, such as hypoxic-ischemic encephalopathy (HIE), intracerebral hemorrhages, infections or metabolic disturbances. Unprovoked neonatal seizures typically occur in the context of genetic disorders or structural brain malformations. This distinction as well as the underlying etiology, are crucial as both significantly influence the prognosis. This review summarizes the current state of knowledge regarding the long-term outcomes of neonatal seizures and their predictive factors. Long-term neurological deficits depend not only on the seizures themselves but primarily on the underlying cause. The HIE is frequently associated with severe long-term consequences such as cerebral palsy and cognitive impairments. Genetic epileptic encephalopathies are usually associated with lifelong epilepsy and neurocognitive deficits, while the extent and localization of structural brain malformations determine the severity of cognitive and motor impairments. Early diagnosis and prompt initiation of treatment are essential. In the short term, mortality is the primary concern and in the long term, neurological sequelae such as cerebral palsy, cognitive deficits, or post-neonatal epilepsy may occur. Identified prognostic factors include the underlying etiology, electroencephalography (EEG) and magnetic resonance imaging (MRI) findings and perinatal risk factors. Further prospective long-term studies are needed to improve care for affected neonates and sustainably optimize their long-term outcomes.</p>