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INTRODUCTION: Seizure emergencies pose significant clinical and healthcare challenges in Spain, impacting morbidity, mortality, and resource utilization. Comprehensive data on epidemiology, clinical outcomes, and economic impact remain limited. METHODS: A systematic review was conducted following the Centre for Reviews and Dissemination (CRD), Cochrane, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Embase, PubMed, and CINAHL were searched (January 2010-April 2025) for observational studies on epileptic seizure emergencies in Spain. Study selection, data extraction, and risk of bias assessment (ROBINS-I) were performed independently by two reviewers. Given reporting heterogeneity, a descriptive narrative synthesis was undertaken. RESULTS: Forty-seven observational studies identified 16 population groups. The analysis focuses on two groups with the most comprehensive data: status epilepticus (SE), epileptic seizures at the emergency department; and in pediatric populations. SE patients experienced extended seizure duration (8-51 h), in-hospital mortality averaging 24.3%, intensive care unit (ICU) admissions between 17% and 48%, and hospital stays up to 24 days, indicating substantial resource utilization. Patients with epileptic seizures at the emergency department exhibited hospitalization rates between 6-32% and medical complications between 19.4% and 52.1%. Pre-hospital benzodiazepines use was between 11 and 38%. Pediatric likely underrepresented populations had lower mortality but frequent emergency visits. No studies assessed quality of life or indirect costs; one reported direct cost in SE. CONCLUSION: Reporting of seizure emergencies in Spain is heterogeneous and biased toward severe cases, likely overestimating per-patient burden while underestimating population impact. Broader data capture and improved early management could inform planning and reduce overall burden.