[Late onset epilepsy]

Epileptic seizures appearing in adulthood are not uncommon. They are usually provoked or involve acute symptoms, but late-onset unprovoked seizures are also frequent. The chance of repeated seizures is high, and when they occur late-onset epilepsy (LOE) is diagnosed. The incidence of LOE, particularly in the elderly, has increased over the past ten years. The etiology of this entity depends to a great extent on age. Idiopathic LOE is quite frequent, especially in the young adult and new epileptic syndromes have recently been described. The percentage of LOE cases attributable to tumors and traumatism is high in the middle-aged adult. Vascular disease and dementia are the main causes of LOE in the elderly. The treatment of LOE follows the general guidelines, but the starting drug doses must be lower and certain antiepileptic must be avoided in the elderly. Seizures are often controlled by a single drug given at comparatively low doses. New longitudinal studies are needed, however, to allow us to formulate new rational therapeutic approaches.