Seizure is a common phenomenon in elderly persons which is important to be diagnosed and treated. In this age group, acute symptomatic seizures are most often seen in the setting of acute stroke and metabolic encephalopathy. Cerebrovascular disease and degenerative dementia are common causes of epilepsy in elderly patients, but one-third of cases are of cryptogenic origin. The majority of late-onset epilepsy is partial with or without secondary generalization and clinicians should maintain a high level of suspicion for possible diagnosis because of atypical presentations. A reliable history taking and paraclinical evaluation is needed to confirm the diagnosis and exclusion of other causes. Antiepileptic treatment in elderly should be started at low dose monotherapy with slow titration to higher doses. Also underlying diseases and other prescribed drugs should be considered. Regular bone mineral density testing and calcium and vitamin D supplementation in need, is recommended.