The treatment of ICU seizures and status epilepticus may differ in the approach taken. With only one seizure, the focus should be more on defining the etiology than on treating the patient with antiepileptics, but with more prolonged or recurrent seizures, both should be pursued in parallel. Status epilepticus, if delayed or untreated, carries a grave prognosis and every ICU should have a protocol for rapid response to this neurological emergency. Continuous EEG monitoring should become mandatory, when treating status, because of the late dissociation between clinical convulsions and electrographic seizures and the inability to use the clinical examination as guide to the treatment. Focal and non-convulsive statuses have a different etiology and prognosis than generalized convulsive status epilepticus, and the treatment also differs. Several medications are available for treating seizures, but only few are available for parenteral, fast administration when treating status. The experience from using the newer antiepileptics in case of resistant status is therefore limited. Interactions between antiepileptics and common ICU medications may be significant and concurrent multi-organ failure may alter their metabolism.