There are two high prevalence groups of epileptic patients, children and the elderly. There are two groups of elderly epileptic patients, one is epileptic patients with onset of seizures in old age, and the other is seizures that continue into old age. According to statistics, about 1/4 of the first epileptic seizures occur after the age of 60, and the trend is increasing year by year. In addition to the direct causative treatment of symptomatic epilepsy, the basic principles of antiepileptic drugs should also be followed in the treatment of geriatric epilepsy, and attention should be paid to the effects of physiological changes on antiepileptic drugs. The preferred drug should be given at low doses and gradually increased. Most of the drugs are metabolized by the liver except for a small number of drugs that are metabolized by the kidneys. Therefore, it is important to understand the liver and kidney function of the elderly before administering the drugs and to pay attention to the drug accumulation caused by the decreased degradability of drugs. Physiological changes in the elderly lead to a greater sensitivity to the adverse effects of antiepileptic drugs. Some antiepileptic drugs can cause cognitive impairment in patients, and for patients with a tendency to dementia, attention should be paid to preventing further cognitive impairment when selecting drugs, and also to the possibility that some drugs for dementia may aggravate epilepsy. In addition common neurotoxic effects should be observed during treatment. Because the elderly are more likely to have multiple co-morbidities and require multiple medications, drug interactions are likely to occur. Therefore, newer non-enzymatically induced antiepileptic drugs may be preferred when there is no major difference in efficacy. Elderly patients are prone to misuse or omission of medications due to memory loss or lack of care, so it is important to educate patients and family members about epilepsy.