1. Pharmacologic management of active seizure in cancer patients starts with benzodiazepines, followed by levetiracetam or lacosamide load. For refractory seizures, intubate and start a benzodiazepine infusion.

2. Tailor a differential diagnosis. Determine whether the seizure was focal or generalized. Obtain a history of their treatments, medications and recent changes, preceding symptoms, and determine if there are residual symptoms or deficits.

3. New seizures in any cancer patient should prompt imaging to evaluate for structural lesion, first with non-contrast CT head followed by gadolinium-enhanced MRI. Focal seizures suggest focal causation.

4. Continuous video EEG is preferred, as shorter EEG may fail to capture non-convulsive status epilepticus (NCSE).

5. Metabolic derangements can present with seizures and is common in patients with oncologic processes. Therefore, a high degree of suspicion and low threshold for repletion of electrolytes and correction of acid-base abnormality is imperative.