Issues regarding management of acute and chronic seizures constitute one of the more frequent consultations that all neurologists encounter. With a significant medical and surgical therapeutic armamentarium now available, many clinicians are perplexed about how to approach the most basic of seizure consultation questions. In this article, four of the most commonly asked seizure consultation questions are reviewed: when antiepileptic drug (AED) treatment should be initiated; how to choose an AED; when to refer a patient for surgery; and when to withdraw AEDs in a seizure-free patient. By utilizing frequently encountered clinical scenarios, the decision-making process to best illustrate application of existing clinical evidence to the individual patient is explored.