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Introduction- The incidence of first unprovoked seizure (FUS) in children is high with a recurrence risk of 40-60% .Whether FUS needs treatment is uncertain. This study was done to assess risk factors which contribute to recurrence in FUS and have implications for treatment and prognostication.  Methodology-Cases-67 Children (1 month - 12 years) presenting with FUS from December 2015 to December 2017 with a minimum 1 year follow up. Clinical details including demographics, seizure semiology, time of occurrence, status epilepticus, birth , development and family history and seizure recurrence if any with complete neurological examination, EEG and neuroimaging findings were included. Exclusion- children with acute symptomatic seizuresResults- Age groups-1. below 5 years= 25 of 67 (37.37%)  2.above 5years age= 42 (62.68%).Abnormal neurological examination was found in 7(10.44%); abnormal EEG in 29 (43,28%) and abnormal neuroimaging in 20 (29.85%) patients. Seizure types- focal- 30 (44.62%), generalized-37(55.22%). seizure presentation - 1)cluster of seizures7(10.44%) 2)status epilepticus 10(14.92%)3)seizures in sleep10 (14.44%). Definite aetiology was found in 23(34.32%) patients with genetic in 5(7.46%), structural in 18(26.8%)Recurrence of seizures was found in 29 (43.28%) patients.21  had recurrence at an average duration of 9 months after presentation. 3(10.34%) with genetic and 7 (33%) with structural cause had recurrence.Using Chi Square test, significant factors associated with recurrence were seizures during sleep, Abnormal EEG , Abnormal EEG and neuroimaging.Conclusion-. It is pertinent to determine the recurrence risk of FUS for optimal treatment and prognostication. Those with seizures in sleep, abnormal EEG and MRI maybe at risk of recurrence.

First unprovoked seizure, recurrence, EEG , MRI