When a person suffers from two or more seizures without any medicinal intervention, he is said to have epilepsy. As opposite to the popular belief, late onset epilepsy, that is epilepsy that starts after the age of twenty, is fairly common. However, the etiology, clinical symptoms, presentation of the case and their further consequences on the person and his socio-psychological behavior are totally different from those in childhood.

It is the associates of the epileptic patient who can give valuable information regarding the onset of epilepsy and type of seizures. However, if the elderly patient is dwelling alone, often the initial diagnosis is missed. Either history of recurrent falls or sudden unconsciousness has to be regarded as the guiding symptoms. Also most of the times, in elderly, incidence of general grand-mal-epilepsy, that is generalized convulsions is rare. They often have focal seizures. This further may make diagnosis difficult. That is why diagnosis of epilepsy in elderly has to be done with great caution and one has to rule out various differential diagnoses in order to avoid miss-diagnosing a case. So, a deep study of epilepsy presentation and diagnosis is the major step towards better treatment and consistent results.

Especially one has to rule out extra-pyramidal diseases while diagnosing focal seizures. Patient may complain of involuntary movement of one arm or one leg. This can occur in partial seizures. Also, one has to rule out low sugar levels in diabetic patient, transient ischemic attacks related to reduced blood supply to a lobe of brain, secondary dementias or psychogenic disorders. Also one has to differentiate syncope from epilepsy. One should also take care of occult cerebral ischemia. The seizures may work as stepping stones for further cerebrovascular damage. Also rule out tumors that may present themselves during late adulthood. Beware of medicines like anti-depressants that may at times lead to seizures.

Whatever is the cause, once the diagnosis is made in elderly, reassurance is the main therapy that they require. The doctor should also put the patient on appropriate anticonvulsant drug therapy like carbamazepine, phenytoin or sodium valproate. But in elderly side effects of the drug may be seen little exaggerated than in children. So, a proper monitoring of the case is must. Management of an elderly epileptic is truly a Herculean task!