The elderly are a substantial and rapidly increasing proportion of the population. They also have a high frequency of seizures, which can lead to serious consequences. The elderly differ from the young in that they may have many medical conditions, take numerous concomitant drugs, have different metabolic characteristics, and are more likely to suffer from neurologic conditions such as stroke. The elderly are also more sensitive to adverse effects of prescription drugs. As available antiepileptic drugs (AEDs) have roughly equivalent efficacy, side-effect profiles are a major determinant in charting therapy. The older AEDs have a well-known collection of undesirable side effects. Newer AEDs have potential advantages for the elderly, particularly with respect to tolerability. The characteristics of seizures in the elderly and guidelines for their treatment are discussed.