Introduction Seizures represent 3% of all emergency department attendances.

Methods A list of all possible seizure mimics was generated from ED computerized triage systems from 1/1/12 to 31/12/13. Data was extracted manually from review of ED notes and analyzed.

Results 905 seizure attendances by 636 patients were examined over 2 years. 340 men and 296 women accounted for them, with average age 33±28 years. 245 patients had a history of epilepsy and were taking at least one AED. >2 AEDs were used by 32 patients. 22 had known Non-Epileptic Attacks (NEAD). Convulsive seizures occurred in 429 and Status Epilepticus in 13. The mode for the number of convulsive events in ED was 2 for NEAD patients and 1 for others. Lactate and neutrophils in NEAD were 1.3±0.3 mM and 4.4±1.2×10^9/L respectively. In other patients with convulsive seizures, they were 3.2 ±3.2 mM (median 2.1) and 6.6±3.1×10^9/L (median 6.1). 73 had neuroimaging acutely. Few patients with NEAD were admitted. 1/3 of convulsive seizures were admitted.

Conclusion This retrospective service audit indicates the burden of epilepsy attendance in a busy hospital. There is a potential role for more acute neurology input to prevent unnecessary admissions, and a pathway for non-epileptic attack sufferers.