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Background: Epileptic seizures (ESs) are common neurological problem in the elderly. The underlying etiology and treatment of ESs is different in elderly due to underlying comorbidities and physiological changes with aging. Precise data on this topic are not readily available from developing countries. Aims: To study the clinical presentation, EEG and Neuroimaging correlation and response to drug treatment in elderly with ESs. Setting and Design: longitudinal descriptive study. Material and Methods: The patients were selected who had ESs first time after 60 years of age, were interviewed, examined, investigated and follow up for 3 months to see the response of drug treatment. Data were recorded on pre-set proforma. Statistical analysis: Used simple percentage and proportion to analysed the data. Results: There were 66 patients (38 male). Mean age was 62.33 year. ESs was partial with or without secondary generalization in 62.12% of cases. Symptomatic localization related epilepsy (LRE) was most common syndrome (66.67 %). MRI suggestive of stroke as a most identifying etiology in 43.93% of patients. Ratio of patients on monotheraphy and polytheraphy was 2.3:1. At the time of last follow up percentage of patients in Engel's score 0-4 category were increased from 4.54% to 54.54%. Conclusion: LREs were the most common type of ESs (76%) with stroke were most common identifying lesions on MRI (43.93%). Most of the patients were on monotherapy (69.7%). Significant reduction in ESs frequency was seen at the time of last follow up.