Objective: To evaluate the role of magnetic resonance imaging (MRI) in describing the brain lesions associated with neonatal seizures, and its prognostic value, in comparison to the commonly used tools as ultrasound and computed tomography (CT). Methods: Twenty term neonates (8 girls and 12 boys) presenting with neonatal seizures, with or without HIE, underwent MRI (mean 21.7 days), as well as CT (n=18) and ultrasound (n=18). The presence and pattern of MR findings were compared with short-term neurologic outcome (mean 16 month).Results: Based on the clinical history and MRI, the causes of seizure activity were hypoxic ischemic encephalopathy (70%), intracranial hemorrhage (15%), cerebral dysgenesis (10%), and inflammatory process (5%). Patients were grouped according to MRI findings as either diffuse injury (55%), focal lesions (15%) and normal study (30%). Infants with diffuse lesions had significantly higher mortality (55%) and morbidity (27%), in contrast to infants with focal lesions, where no infants died and 33% had minor developmental delay (P value 0.048). Out of the patients with normal MRI, 67% were normal on follow-up, 17% showed minor developmental delay and 17% died.Conclusion: MRI with its high sensitivity and anatomic resolution contributes important information about the nature of neuropathology underlying seizure activity, and yields significant predictive information, which is critical to prognosis.