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Objective: To determine the association between epilepsy disease (ED) and consanguinity in the tribal society of Khyber Pakhtunkhwa-Pakistan. Material and methods: Approximately, 150 clinically diagnosed epileptic patients of consanguineous families with ages ranging from 3 to 70 years were included during the period of (2018-19). Children in this study were aged 7-10 years and male to female ratio among the patients was 1:1.5. The target familial cases were included on the basis of sex. age. parental consanguinity, seizure type, cause of epilepsy, and family history. The parents were interviewed to collect the required information after informed consent. Non-consanguineous families, patients with acquired causes, and those who were not willing to participate were excluded from the study. Results: In the current study, the consanguinity in parents of the epileptic patients was compared with the general population and we found significant results (P< 0.01). Generally, 56 (37.33%) of the patient's parents were first cousins with (OR=3.245 and 95%-CI =2.26-4.645 and P<0.0001), 24(16.00%) were second-degree cousins with (OR=3.269 and 95%-CI=2.032- 5.258 and P<0.0001) and 70 (46.66%) were unrelated. Conclusion: The overall results in this study clearly indicate the potential role of heritage lineage/consanguinity in epilepsy within consanguineous families. The present retrospective study supports genetic counselling prior to marriages. More significant genotype-phenotype correlation is also needed to minimize the risk of epilepsy disease. [ABSTRACT FROM AUTHOR]