Introduction: The risk of seizures is the highest in infancy but there is not much data from this region on infants with first seizure.

Methods: We studied 75 (61.3% males) consecutive infants (28 weeks-1 year) presenting with their first seizure to the pediatric emergency. Seizures were classified as per ILAE Classification, 1981. Seizure semiology was determined based on eye-witness account (77.3%), or direct observation. Routine biochemical studies, inter-ictal EEG, and developmental assessment were done in all infants. Neuroimaging was done selectively.

Results: Mean age was 5.8±3.4 month and 42.7% had seizures as their only complaint; fever was the most common co-morbidity. 57 (76%) patients presented with a first seizure. 93.3% infants had short-lasting (<15 min) and generalized (72%) seizures. Biochemical studies were abnormal in 27 (36%), with hypocalcemia in 26. 12 CT scans and 10 MRI studies were done in 20 patients. In unprovoked seizures, only 31% of these provided any diagnostic information. Majority of the infants had provoked seizures (68%), 1/3^rd of which were due to hypocalcemia. 29.3% had neuroinfections (pyomeningitis, 21.3%). Eight (10.7%) infants had febrile seizures and 5 had Benign infantile convulsions. Thirteen (17.3%) infants had developmental delay, with majority having moderate delay. Nine (12%) infants died during the duration of the study, 2 during the course of a seizure.

Conclusion: Metabolic derangements and neuro-infections were the commonest etiology. Existing management guidelines for infants with an initial seizure need to be modified for our region.