Seizures in the intensive care unit may occur in 3–34% of patients based on the etiology. This chapter intends to provide an overview of controversies regarding management, highlighting recent evidence from the literature and the latest guidelines. Continuous monitoring of the electroencephalograph (EEG) is helpful for early detection and guiding the management of nonconvulsive status epilepticus in high-risk etiologies. Despite the introduction of newer antiepileptic medications, phenytoin and levetiracetam continue to be used in routine clinical practice, although the use of phenytoin may be declining. Evidence continues to emerge regarding the optimal drugs, time duration of treatment, and weaning of anesthetic medications for refractory status epilepticus. The treatment protocol of nonconvulsive status epilepticus remains largely extrapolated from the same for convulsive status epilepticus, although newer agents like topiramate, perampanel, and lacosamide continue to be explored. Long-term seizure prophylaxis in acute brain injury can be guided by clinical and electrographic risk scores.