Objective To analyze the clinical characteristics of seizures in children with acute lymphoblastic leukemia (ALL) during treatment. Methods The clinical data of children diagnosed with ALL complicated with seizures from January 2011 to June 2019 were analyzed retrospectively. Results A total of 978 children with ALL were admitted, of which 51 (5.2%) developed seizure symptoms after ALL treatment, 39 males and 12 females, with a median age of 7.4 years (3.7-11.1). Their common etiologies were chemical drug neurotoxicity (12 cases), intracranial hemorrhage (7 cases), hyponatremia (6 cases), white matter encephalopathy (5 cases), febrile convulsions (5 cases), and reversible posterior encephalopathy syndrome (4 cases). First seizures were relatively common with generalized seizures, and depending on the cause of the seizures, they were often accompanied by impaired consciousness, focal symptoms and other clinical features. A total of 39 children in this group underwent cranial CT or MRI after the first seizure, and 27 were abnormal. In the 30 cases with successful follow-up, 14 cases had abnormal imaging, including 8 cases with reversible foci and 4 cases with cerebral softening foci. Twenty-eight cases had abnormal EEG results after the first seizure, mainly with medium-high amplitude slow wave emission. Of the 30 children successfully followed up, 18 had no significant sequelae. Conclusion Seizures are common neurological complications in children with ALL during treatment. The etiology of the first seizure and its accompanying clinical characteristics are diverse. Timely neuroimaging and EEG examinations are helpful for early diagnosis and treatment.