About half of the causes of epilepsy in the elderly are unknown, and the most common cause is stroke, accounting for about 1/3 of patients; degenerative diseases (such as Alzheimer’s disease) account for about 11%; tumors account for about 5%, traumatic brain injury accounts for about 2%, and infection accounts for about 1%. In addition, the elderly are more likely to suffer from various medical, neurological and psychiatric disorders (such as metabolic disorders resulting in blood sugar and ion disorders, endocrine disorders such as diabetes, thyroid/parathyroid disorders), and are therefore more likely to induce seizures. 2. Is epilepsy common in the elderly? There are two peak periods of epilepsy onset, one in childhood and one in old age. In fact, there are more newly diagnosed epilepsies in the elderly than in the middle-aged population. 3. What diseases are easily confused with epilepsy in the elderly? Disorders that can be easily confused with epilepsy include transient ischemic attacks, transient amnesia, syncope, migraine, tremor, and anxiety attacks. In young people, epilepsy mostly originates in the temporal lobe, while in older people, symptoms are more often found in the frontal, parietal or occipital lobes, which can be easily confused with other disorders. For example, the most common aura seizure in the elderly with epilepsy is dizziness, which is also often the most common manifestation of other (e.g., stroke). Second, seizures are often less pronounced in older adults than in younger adults and may be mild, which can lead to neglect or misdiagnosis. In addition, the type of seizure in older adults is often a complex partial seizure, manifested by hazy consciousness or memory impairment, and often cannot clearly recall what happened afterwards, which also makes diagnosis difficult, especially when living alone. 5. How is epilepsy diagnosed in the elderly? As with other epilepsy diagnoses, a detailed seizure history, combined with physical examination and past medical history, laboratory tests including: blood and urine routine, blood biochemistry, liver and kidney function, MRI, cardiac function assessment (if necessary), and for patients with frequent seizures and difficulty in defining the nature of the seizures, a video-EEG examination is required to clarify the nature of the seizures. Finally, the above results are analyzed together to diagnose or exclude epilepsy. 6. Epilepsy and medication in the elderly It is important to tell the doctor truthfully what medications you are taking and whether there are any problems with liver and kidney function. There is a possibility that these drugs and antiepileptic drugs may affect each other or even conflict. For example, warfarin with certain antiepileptic drugs (such as phenytoin sodium or carbamazepine) may reduce the effectiveness of warfarin. Because most drugs, including antiepileptic drugs, are metabolized or cleared by the liver or kidneys, if there are problems with liver and kidney function, the drugs will be metabolized and eliminated at a slower rate, and drug side effects or even toxic reactions may occur. In fact, because the liver and kidney function of the elderly is also not as good as that of young people, the regular dose of medication for the elderly is lower than that of young people, and the initial dose is usually lower than that of young people and needs to be increased more slowly. 7, epilepsy and falls in the elderly Elderly patients with epilepsy, taking anti-epileptic drugs (such as phenytoin sodium, carbamazepine) and drugs with obvious sedative effects (such as phenobarbital, clonazepam, etc.), coupled with unstable walking, it is easy to fall, so we must pay attention to prevent falls, because: 1. falls are prone to fractures → may be forced to bed and need family care → poor health renewed illnesses → affect life; 2. Falls can cause head trauma → cranial hemorrhage → aggravate seizures → cognitive and behavioral problems and even life-threatening. Studies have shown that patients with epilepsy taking liver enzyme-inducing drugs (such as phenytoin sodium, phenobarbital and carbamazepine) have a higher incidence of bone loss and osteoporosis compared to the normal population. In addition, it is important to exercise caution to prevent falls and fractures.