This study was designed (1) to compare the prevalence of emergency department (ED) presentations in Western Zone Sydney South West Area Health Service (WZS) between 1998–2002 and 2003–2007 for epilepsy (including status epilepticus (SE) and convulsions), hospital admission rates, and proportion of first seizure presentations; and (2) to compare these data with those for New South Wales (NSW) and Australia-wide figures. Using health department data sets, we found 19,834 presentations to WZS EDs between 1998 and 2007 (24.85/10,000 population/year). When the periods 2003–2007 and 1998–2002 in WZS are compared, ED presentations fell by 3% (P = 0.03) and hospital admissions fell by 6% (P = 0.001). The prevalence of ED presentations for seizures in NSW did not change (P = 0.92), but hospital admissions fell by 3% (P < 0.0001). When 1999/2000–2002/2003 was compared with 2003/2004–2006/2007, the prevalence of hospital admissions in Australia fell by 1% (P = 0.0002). Rates of presentation for epilepsy in WZS have fallen over the last decade. Most presentations were first seizures rather than recurrences. The reason for this is speculative, but may reflect improved levels of education and health care delivery.