Foreign epidemiologic studies have confirmed that the incidence of epilepsy among the elderly is higher than that in children. A study carried out in Hisayama in Japan also revealed that the prevalence of epilepsy was significantly higher in the elderly population (aged≥65 years; 10.3 per 1000) than that in the middle-aged population. As a result, opportunities to treat epilepsy among the elderly are increasing in general psychiatric settings. Among elderly patients, focal epilepsy occurs most commonly and focal (onset) impaired awareness seizures are often observed. However, generalized tonic-clonic seizures are relatively rare. Impaired awareness seizures are not commonly recognized as a symptom of epilepsy; therefore, in order to improve the diagnosis, it is important to encourage the patients and their families to provide detailed descriptions of the symptoms. Video recording a seizure may also prove useful for an accurate diagnosis. The use of anti-depressants may cause nonconvulsive status epilepticus (NCSE). The examination of an electroencephalogram is important for the diagnosis of NCSE because it reveals alternations in the state of consciousness. It is essential to differentiate between geriatric epilepsy and dementia, as transient epileptic amnesia and focal (onset) impaired awareness seizures may be misdiagnosed as dementia. Recent studies reported that epilepsy in the elderly is often comorbid with cognitive decline. Moreover, epileptiform activity may also suggest cognitive dysfunction. As a consequence, epilepsy in the elderly is important for a differential diagnosis and as a comorbidity of dementia. Furthermore, epileptic discharge may deteriorate cognitive symptoms. Considering that the treatment response is good in the elderly, appropriate therapy may also prevent cognitive dysfunction. Enzyme-inducing anti-epileptic drugs may influence pharmacokinetic interactions, leading to numerous comorbidities, including osteoporosis and lipid metabolism disorder. Therefore, it is important to consider utilizing alternate forms of medication. The diagnosis of epilepsy may also have a social impact, as the safety of patients with impaired awareness seizures is not guaranteed. During treatment, the psychological impacts of this diagnosis must be an important consideration.
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