Objective: To determine the association between risk factors and new-onset seizures in old age population at a tertiary care hospital, Karachi. Methods: A case control study on old age patients of > 60 years visited emergency department (ED) either with new onset seizure or without seizure were conducted at ED of Ziauddin University Hospital Karachi. 154 consecutive old age patients were distributed into two groups i.e., case group (77 old age patients of new onset seizure) and control group (77 old age patients without seizure). Risk factors including stroke, dementia, head trauma, metabolic causes, brain tumor, infection of central nervous system (CNS), depression and anxiety were evaluated. Results: Out of 154 old age patients, male was 32 (41.6%) and 40 (51.9%) and female was 45 (58.4%) and 37 (48.1%) in case and control group respectively. Type of seizure in control group was generalized tonic–clonic seizure (GTCS) in 51 (66.2%) patients and focal seizure in 26 (33.8%) patients. Comorbidities were diabetes mellitus (DM) in 76 (98.7%) and 59 (76.6%) patients, hypertension (HTN) in 72 (93.5%) and 63 (81.8%) patients and ischemic heart disease (IHD) in 39 (50.6%) and 25 (32.5%) patients. Risk factors were stroke in 23 (29.9%) and 16 (20.8%) patients, dementia in 3 (3.9%) and 0 (0.0%) patients, head trauma in 0 (0.0%) and 33 (42.9%) patients, metabolic causes in 27 (35.1%) and 27 (35.1%) patients, brain tumor in 6 (7.8%) and 0 (0.0%) patients, CNS infection in 17 (22.1%) and 1 (1.3%) patients and depression in 2 (2.6%) and 0 (0.0%) patients. Conclusion: New-onset seizures are significantly associated with age, diabetes mellitus, hypertension, ischemic heart disease, brain tumor and CNS infection.