[Epilepsy in the elderly]

Epilepsy is one of the most frequent neurological diseases in the elderly. Its incidence and associated-mortality rise in old age. Distinguishing epilepsy from paroxysmal non epileptic events can be a real challenge for physicians. Diagnosis of epilepsy relies on clinical examination but routine laboratory tests and cerebral imaging are warranted, especially for first-ever event. Electroencephalogram is important for the evaluation of seizures in elderly patients but it may show non specific changes associated with age. Clinical presentation in old age is often less-specific. Partial seizures are more common than generalized. Acute symptomatic seizures are very frequent most often due to metabolic abnormalities; infections or medications. Although the international classification of epilepsy is well known, its use is not easy in the elderly We favour a geriatric model of reasoning, which takes into account the effects of aging, chronic diseases and acute precipitating factors, because it is more beneficial to the patient. Based on this model, an electro-clinical scale has been created (but not yet validated) to help practitioners with the diagnosis. When initiating the treatment, monotherapy is always preferred. The choice of a molecule must be individualized. Efficacy, but also antiepileptic drug side-effects (alertness, cognitive effects), and interactions must be taken into account in this vulnerable population.