Nonepileptic events misdiagnosed as manifestations of epilepsy are a significant problem. Five representative cases suggest that a diagnosis of epilepsy should be based on a careful history and analysis of the clinical event. The clinician should make a diagnosis of epilepsy only when there is definite positive support and not on the basis of poorly characterized paroxysmal episodes and a few minor and nonspecific EEG findings. Effective treatment presupposes correct diagnosis and early diagnosis appears to be correlated with better prognosis. The annual cost of nonepileptic spells misdiagnosed as epileptic can be estimated at between $650,000,000 and $4,000,000,000. Aggressive efforts to establish a definite diagnosis of spells not clearly epileptic is both medically and economically indicated.