Epilepsy and the elderly

The highest incidence of new-onset epilepsy occurs in individuals over the age of 60. Seizures can be either provoked or unprovoked. Metabolic disturbances and alcohol withdrawal are common causes of acute provoked seizures, and treatment is directed towards the underlying provoking medical condition. In contrast, the diagnosis of epilepsy is made when a patient experiences recurrent unprovoked seizures. This article addresses the type of epilepsy older individuals experience, the causes of new-onset epilepsy in the elderly, the diagnostic evaluation of the older patient with spells of alteration in level of consciousness, and the treatment of epilepsy in the elderly.