Epidemiologic studies of seizure disorders among US blacks and inner city residents are rare. Employing a case-control design, this investigation used the emergency room records of Harlem Hospital in New York City to examine sociodemographic, clinical, and service-use characteristics of seizure patients. Approximately 96% of the cases (314) and of the controls (436) were black. Compared to the controls, seizure patients were older and more often male. Cases were transported to the emergency room by ambulance significantly more often than controls regardless of the interval since the seizure. Interval since the seizure was related to the likelihood of hospital admission. Women with seizures had a significantly higher rate of hospital admission than female controls. Seizures were strongly associated with indications on the record of alcohol abuse. The odds of an adult male or of an adult female alcoholic attending the emergency room for seizures were approximately seven times that of a same-sex nonalcoholic control. Whether abuse of alcohol plays a major etiologic role in the onset of seizures or serves only to precipitate convulsions in individuals already vulnerable to seizures remains an open question.