Cerebral granulomas, due to infections, have been rarely reported as a cause of late onset epilepsy. The incidence of cerebral granulomas was 7% in this prospective study of 56 consecutive patients with onset of seizures after the age of 20 years. Other main causes included cerebral tumours (20%), arteriovenous malformations (5%) and cerebrovascular disease (15% amongst patients with onset of seizures above the age of 40 years). The incidence of structural abnormalities was higher with increasing age at the onset of seizures and declined with long duration of history of epilepsy. Simple partial seizures were strongly associated with structural abnormalities (86%) as opposed to complex partial (33%) and generalised tonic-clonic seizures (33%).