Mc Manus E, Gilbertson L, Timmings P, et al. - This study was undertaken to evaluate the long‐term diagnostic accuracy of our First Seizure Clinic (FSC) by evaluating the risk of subsequent seizures in our FSC cohort and to ascertain what proportion of the researchers' First Seizure referrals reflected true unprovoked first seizures or epilepsy. Data were prospectively obtained from 200 adult patients referred to the FSC between May 2014 and December 2015. Clinical notes and electroencephalography data were evaluated and a telephone follow‐up at 28‐month post‐diagnosis was done. The outcomes indicate that 50% of patients referred to an FSC had not had a seizure but were given a different diagnosis. This research also demonstrates that the risk of seizure recurrence after a first seizure is low because a large proportion of these patients already received a diagnosis of epilepsy at the initial evaluation. A history of previous seizures seemed to be the reason for the high proportion of individuals being diagnosed with epilepsy. A low probability (5%) of seizure recurrence was seen in those who were given an alternative diagnosis at the first assessment.