Seizures are a common presentation of brain neoplasms. Both primary brain tumors and metastases can present with seizures, which are more commonly focal, but frequently generalize depending on the location and the pathology of the lesion. In general, more benign tumors have a higher incidence of seizures than more malignant ones. These patients are admitted to an ICU either for preoperative monitoring or in the postoperative period. They should be treated with antiepileptics only if clinical seizures are noted or subclinical seizures detected by EEG. The question remains if patients should be prophylactically treated with antiepileptic medications, if seizures have not occurred yet in the pre- and postoperative period and for how long. More recent data and guidelines do not support such prophylactic administration.