A common care location for seizure and epilepsy patients is the emergency department and inpatient setting. A thorough history to discern a specific diagnosis and localization guides testing and treatment decisions. These decisions include the need for additional imaging/laboratory testing and whether to start an antiseizure medicine (ASM). Electroencephalograms (EEGs) are often required with time length depending on clinical question. If an epilepsy diagnosis is certain without clear localization, one hour of testing is preferred. If the question (or diagnosis) is status epilepticus, 24-hour EEG is indicated. For patients with known epilepsy, ASM alteration can occur for seizures with appropriate compliance. If there is noncompliance, an ASM increase may not be required. The perioperative period requires ASM continuation, although the administration route may change. Patients with renal or hepatic impairment often necessitate dose adjustment. Specific situations like alcohol withdrawal seizures have accepted paradigms to follow and are discussed. Lastly, patients in epilepsy monitoring units (EMUs) are hospitalized for diagnostic reasons with management needs different than other epilepsy patients.