[Epilepsy in the very old]

Epilepsy ist the third most common neurological disease of the elderly. In the elderly the incidence is higher than in childhood and adolescence. Cerebrovascular diseases are in 50% of the cases the most common cause for a seizure beyond the age of sixty. The importance of neoplasias is often overestimated. The risk for a renewed seizure after a first seizure is higher in the senium than in youth. Furthermore, the incidence of seizure-related injuries is increased in the elderly and therefore, anticonvulsive therapy must be started early with guaranteed compliance. With regard to therapy, the altered pharmacokinetics in senium must be considered. The drug of first choice is carbamazepine. If a monotherapy with carbamazepine, phenytoin or valproate does not control the seizures a combination with one of the new antiepileptic drugs must be initiated. Due to their pharmacokinetic characteristics, the new drugs-such as vigabatrin, gabapentin and lamotrigine-are specially suitable in the therapy of elderly patients. In case of undesirable side effects, monotherapy with one of the new anti-convulsants ought to be considered.