BACKGROUND: Febrile seizure is the most common convulsive event during childhood, but it is generally considered benign. OBJECTIVES: To estimate the rate of epilepsy after first presentation of febrile seizure and to describe factors that can predispose children to have subsequent epilepsy after their first febrile seizure. DESIGN: Retrospective chart review. SETTING: A tertiary care center in Riyadh. PATIENTS AND METHODS: All children whose first febrile seizure developed between 2009–2012, and who were admitted to the pediatric wards. MAIN OUTCOME MEASURES: The rate of epilepsy and prognostic factors for epilepsy following first febrile seizure. RESULTS: Of 109 febrile seizure patients, 6 (5.5%, 95% CI: 2.1% - 11.6%) were diagnosed with subsequent epilepsy 5 to 46 months after their first febrile seizure. The risk of having subsequent epilepsy was higher in children who were convulsing at a low-grade fever during their first febrile convulsion (P=.02). Moreover, delayed vaccination status (P=.03), prolonged duration of the first convulsion (P=.04), frequent febrile seizures (P=.01), and fever without documented infection (P=.03) during the first febrile convulsion were associated with epilepsy. CONCLUSION: The rate of epilepsy following first febrile seizure in Saudi children is within the range of values reported in different populations. Although most childhood febrile seizures are self-limiting, careful observation is needed, particularly for children who exhibit factors associated with epilepsy. LIMITATIONS: Conducted at a single center in Saudi Arabia, which may limit generalizability.