Seizure incidence is higher in the elderly than any other age group. Diagnosis of epilepsy is often delayed because of the many conditions common in elderly patients that can mimic seizures. Video-EEG monitoring is often helpful for accurate diagnosis. Treatment with antiepileptic drugs (AEDs) is complicated by comorbidity, co-medications and age-related changes in pharmacokinetics and pharmacodynamics. These considerations require careful selection of AED treatment and dosing in order to maximize efficacy and minimize the potential for adverse effects and drug interactions. Lamotrigine and gabapentin seem to be more effective than carbamazepine because of their improved tolerability. While the primary goals of treatment, including freedom from seizures, absence of adverse effects and overall maintenance of a high quality of life, are the same for all patients with epilepsy, the aforementioned issues pose significant considerations in the elderly population when making management decisions.