Evaluation of management and referral pattern is very important in the organization of medical services for epilepsy. In order to study the management and referral pattern of epilepsy, a structured questionnaire was administered to 100 epilepsy patients attending a referral hospital in Kerala State, India. Of these, 61.4% of them were living in villages; 65% had a monthly income less than Rs. 1000. Seventy-five percent of the patients had generalized seizures. The mean delay in diagnosis was more for those from villages (13.5 months) as compared to those from urban areas (6.4 months) and for women (11.7 months) as compared to men (7.8 months). Previous consultation before referral to this Institute included general practitioners (61%), specialists (50%) and neurologist or neurosurgeon (27%). Eighty-eight patients have had EEG and 51 patients have had CT Scans. Thirty-nine per cent of patients required hospitalization for control of seizures that was significantly (P = 0.036) higher among those living in an urban area. Seventy-five per cent of patients were collecting drugs from private pharmacies. No patient was collecting antiepileptic drugs from government institutions even though such a facility was available within 5 km of their residence. This study has revealed that the organization and delivery of neurological services for epilepsy leaves much to be desired.