[Epileptic seizures in the elderly; diagnostic problems]

Epilepsy is increasingly becoming a disease of the elderly. Specific, age-related problems make its diagnosis often difficult. The signs and symptoms may not be recognized by patient, family or physician. The (hetero)anamnesis is often incomplete and confounded by atypical or unrelated complaints. Classical signs of lobar epilepsy are often indistinct. Physical examination and neuroimaging may provide misleading clues. Electroencephalography has a low sensitivity in the elderly. Nonconvulsive status epilepticus is especially difficult to recognize clinically, and has a high morbidity. Still, epilepsy remains a treatable condition so that a thorough diagnostic workup is warranted in all cases.