Background: To determine whether the presence of seizures in patients with spontaneous intracerebral hemorrhage (ICH) was associated with in-hospital complications and measured outcomes. Methods: This prospective cohort study from the China National Stroke Registry included consecutive patients with ICH between August 2007 and September 2008. In-hospital complications, functional outcomes, and mortality at 3, 6, and 12 months were compared between patients with seizures and those without seizures occurring at ICH onset and during hospitalization. Poor functional outcome was defined as a modified Rankin Scale score between 3 and 6. Poor functional outcome and mortality were stratified by stroke severity using Glasgow Coma Scale scores on admission. Results: The study included 3216 patients with ICH and 139 of them (4.3%) experienced seizures. The presence of seizures was associated with high in-hospital complications including atrial fibrillation (P = .004), pneumonia (P = .001), as well as lower rehabilitation assessment rates (P = .033) compared with patients without seizures. ICH patients with seizures had poorer functional outcome at 3-month (P = .012), 6-month (P = .007), and 12-month (P = .001) follow-up. They also had higher mortality at 3 months (P = .045), 6 months (P = .005), and 12 months (P = .002). Patients with mild strokes had poorer functional outcome and higher mortality (P < .005) if seizures occurred. Conclusions: The presence of seizures in patients with ICH was associated with high in-hospital complications and indicates poor outcomes at 3-, 6-, and 12-month follow-up. Quality improvement strategies targeting ICH patients with seizures especially mild stroke may help improve prognoses.