This chapter describes seizures in systemic disorder. Seizures can be classified in several ways; we tend to classify them broadly as provoked and unprovoked depending on an underlying triggering factor. A person who has two or more unprovoked seizures is said to have epilepsy, hence epilepsy can defined as syndrome of recurrent unprovoked seizures. Epilepsy usually requires long-term antiepileptic drug therapy whereas acute symptomatic seizures require treatment of underlying cause; however short-term antiepileptic therapy may be needed till the acute insult is resolved. This chapter covers the metabolic and electrolyte abnormalities and seizures, medication induced seizures, liver failure, renal failure, parathyroid failure, thyroid failure, pituitary failure, systemic infection and fever, alcohol and seizures, seizures in cancer patients, seizures following organ transplantation, and choice of anticonvulsants in acute medical illness.