A five-year retrospective study was conducted to review 91 emergency patients with first time major motor seizures who were hospitalized. Patients were reviewed with regard to etiology of seizures, evaluation, and hospital course. Our objectives were to compare admission and discharge diagnoses, to establish a screening survey which might determine the need for immediate admission, and to evaluate the sensitivity of tests used in diagnostic evaluation. The emergency department diagnosis was in agreement with the discharge diagnosis in 89% of cases. A screening system included a history, physical examination, urinalysis, complete blood cell count, electrolytes, blood urea nitrogen, glucose, electrocardiogram, and arterial blood gases more than one hour post-seizure. When applied to the cases, it distinguished need for admission in 90 of 91 patients. Skull radiographs, electroencephalograms, CAT scans, brain scans, and lumbar punctures were helpful in making a specific diagnosis, but not in determining the need for immediate admission.