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Posttraumatic seizures (PTS) are an important complication of head injury, and their management is frequently a central pharmacologic consideration in patients recovering from these injuries. A comprehensive review of the literature regarding posttraumatic seizures over the past 50 years is presented, addressing incidence, natural history, and characteristics predictive of their appearance. Treatment issues regarding anticonvulsant prophylaxis and symptomatic management are also discussed. Emphasis is directed towards addressing issues related to prophylaxis of PTS in the adult patient with severe head injury, particularly those encountered in the rehabilitation setting.