[Epileptic seizures in the elderly].

Given current demographic trends, the prevalence of epilepsy in the elderly population will increase. This review summarizes the most relevant clinical and therapeutic findings in elderly patients with epilepsy. Guidelines, systematic reviews, and meta-analysis are lacking, and there are only three randomized controlled trials of epilepsy in the elderly. Clinically, seizures in the elderly may be overlooked since warning signs (auras) and seizure evolution into generalized tonic-clonic seizures are rarer in old people. Sudden loss of consciousness occurs more frequently with increasing age, challenging differential diagnosis. Therapy is more complex due to frequent comorbidities and multiple drug therapies, requiring a cautious approach. Especially drug interactions need to be considered. Epileptic seizures seem to be better controlled by drugs in the elderly than in young people. Therapy is hampered by side effects and drug interactions, making definite diagnosis indispensable and bringing on the need for newer-generation antiepileptic drugs.