We studied 197 survivors of 290 very-low-birthweight (VLBW, < 1,500 g) infants admitted to our neonatal intensive care unit from 1977 through 1982. The children were all followed until at least age 6 years (mean 10 years 6 months). Eight children (4.1%) had epilepsy: 5 had generalized, 2 had unilateral, and 1 had partial seizures. Two (1.0%) had active and poorly controlled epilepsy. Three had a history of epileptic seizures, but none for > or = 6 years, and 3 were no longer receiving antiepileptic drug (AED) treatment. Most (5 of 8) were severely multiply handicapped. As compared with VLBW children without epileptic seizures and neurodevelopmental abnormalities, VLBW children with epileptic seizures had a gestational age < 27 weeks, a weight < 1,000 g, severe perinatal complications as indicated by an Apgar score of < 4 at 5 min, and the need for long-term oxygen administration.