Context: The elderly are the most rapidly growing segment of the population. When compared to other age groups, the incidence and prevalence of seizures and epilepsy are higher in the elderly. Clinical manifestations and causes of seizures are different in older age group than in younger ones. In addition, establishing the diagnosis of seizures in old age can be more difficult than in younger people because of the extensive range of differential diagnoses. Aims: To analyse and find out the various aetiologies and clinical characteristics of late onset seizure. Settings and Design: This was an observational study, designed to analyse patients more than 60 years of age and who presented with new onset seizure in their lifetime. The sample size was 80 and the study period was from December 2016 to February 2018. Clinical data was collected from patients and witnesses in a systematic manner and added to a database, which included a checklist of seizure antecedents and the symptoms associated with seizure. Methods and Material: Total number of 80 patients whose age ranged from 60 to 84 years were included. Analysis initiated with history, neurological examination and clinical examination of other systems. Investigations like blood sugar, urea, serum creatinine, sodium, potassium, calcium, magnesium, 12 lead electrocardiography and other relevant investigations were carried out. All the patients underwent neuroimaging with CT brain. Interictal EEG was done for all the patients. Statistical analysis used: The data was entered in MS Excel and appropriate simple frequencies and statistical were used for data analysis. Results: Aetiologies found in this study were: seizure due to metabolic disturbances 33.7%, cerebrovascular disease 26.2%, malignancy related seizures 6.2%, seizure in calcified cerebral granuloma 3.7%, others 7.5%. In remaining 22.5% patients, cause could not be found (idiopathic seizure). Generalized tonic clonic seizure (GTCS) was the commonest semiology, seen in 83.8% patients and focal seizures in 12.5% patients. In remaining 3.8% patients, started as focal followed by secondary generalisation. EEG abnormalities were noticed in 25 patients. CT brain abnormalities were noticed in 28 patients. Conclusion: Our study illustrates the various causes and clinical characteristics of late onset seizure. In a patient with late onset seizure, all efforts to identify the aetiology should be made out. Thorough search to rule out metabolic disturbances and other treatable causes for seizures should be given early priority. Blood biochemistry, CT brain and EEG are indispensable in patients more than 60 years with new onset seizures. 

Keywords: Seizure; Late Onset; Elderly; Aetiology; Stroke; Metabolic Disturbances and Neuroimaging