There are about 9 million people with epilepsy in China, and 1/4 of them are elderly patients. Epidemiological survey data show that the incidence of epilepsy is significantly higher in the elderly group than in other age groups. With age, the physical function of the elderly declines and various diseases come along with it. Most geriatric epilepsies are secondary to epilepsy, about 40% are caused by cerebrovascular disease, and other more common causes include traumatic brain injury, intracranial infection, alcoholism, metabolic abnormalities, and brain tumors. ”The clinical symptoms of seizures in the elderly are diverse and mostly atypical, making it easy to misdiagnose and miss the diagnosis. For example, some seizures manifest as memory confusion, bizarre behavior or unresponsive state, similar to dementia, and are easily misdiagnosed; others manifest as a few seconds of dazedness, which is often overlooked. For elderly patients with suspected seizures, relevant examinations such as head CT or MRI are recommended to detect physical disorders; at the same time, dynamic video EEG is performed to determine the presence of epileptic discharges and to clarify the type of seizures.” With advanced epilepsy EEG monitoring systems, patients can be monitored continuously for 24 hours, or even longer, and this monitoring can provide an important clinical basis for confirming the diagnosis of epilepsy patients, clarifying the severity of the condition, and guiding treatment. Older patients with epilepsy often have co-morbidities with other systemic diseases, so treatment needs to be synchronized with other diseases as well. “The primary treatment for elderly patients with epilepsy remains pharmacotherapy, and the choice of multiple antiepileptic drugs or increased doses needs to be considered holistically, as this can exacerbate multiple organ dysfunction.” Appropriate medication can effectively control seizures in most patients. However, in patients with severe epilepsy, even multiple medications are less effective. Prolonged seizures and medication can damage brain and liver cells, leading to memory and disorientation in patients with liver function impairment, which can be fatal in severe cases. ”For patients with refractory epilepsy that cannot be controlled by medication, surgical treatment is an option through a rigorous preoperative evaluation.” Neuromodulation techniques control seizures by destroying the nucleus accumbens or in vitro neuromodulation in a way that disrupts or inhibits the conduction pathways of subcortical epileptic discharges. This minimally invasive surgical approach has been accepted by an increasing number of patients. We believe that with the continuous development of medicine, the complex epilepsy will become a simple disease that can be controlled and treated.