Introduction: A range of etiological groups are associated with epilepsies and epilepsy syndromes, with emphasis on those that have implications for treatment. The 2017 ILAE classification of epilepsy and epileptic syndromes has proposed six major etiological groups.

Methods: Prospective data of 200 patients followed up in a tertiary pediatric epilepsy clinic after conforming to inclusion and exclusion criteria was studied. The patients were assigned the respective etiological categories after documenting detail history and available investigations. We classified all patients into 6 major etiological groups as per 2017 ILAE classification i.e., Structural, Infective, Metabolic, Genetic, Immune and Unknown category.

Results: Structural etiology is the most common known etiological diagnosis which is seen in 42% of our patients contributed by perinatal insult in 25% of the population with a documented NHBI cases in 8%,CNS malformations in 5% and other  mixed causes of  structural etiology in 12.5.%.Genetic etiology affected 17% of patients of which 3.5% had confirmed genetic diagnosis. The infective and metabolic etiology is seen in 3% and 1.5% cases respectively. In about half the population i.e. 45% etiology could not be determined.13 patients (6.5%) had multiple etiologies.

Conclusion/Discussion: The structural etiology contributed by the perinatal insult and NHBI is the commonest known etiology of epilepsy in a developing country. The infective etiology has declined than before. The genetic etiologies have become significant and hence contributed to the decline in unknown cause. Burden of unknown etiologies remains still the highest.