New patients attending a specialty epilepsy clinic have a diagnosis other than epilepsy. A number of studies have shown that syncope is commonly misdiagnosed as epilepsy, largely through ignorance of the complex prodrome that may occur, and the sometimes dramatic nature of a clinical event that shares many features with epileptic convulsions. Migraine, non-epileptic seizures (NES), hyperventilation and vertigo are other conditions commonly misdiagnosed as epilepsy. Less common disorders that are confused with epilepsy include cerebral ischaemia or paroxysmal symptoms of demyelinating disease, raised intracranial pressure, Tourette syndrome and other movement disorders. Transient global amnesia is a condition of uncertain aetiology, in which the predominant feature is an episode (or recurrent episodes) of anterograde amnesia. From all perspectives, the diagnosis of epilepsy requires clinical skill and judgement, and it is incumbent on the clinician to attach a definite diagnosis only if certain.