The elderly population (Z age 65) continues to grow; this increase extends even to the oldest of the old (Z age 85). This aging population is accompanied by an increase in the cases of epilepsy, which can be especially difficult to diagnose and treat. Age-related difficulties in optimum treatment arise from increased drug sensitivity, altered drug metabolism, comorbid conditions, concomitant multiple medications, inability to self-report symptoms, and drug cost. Although the older antiepileptic drugs (AEDs) are still appropriate treatment for some of the elderly, the newer AEDs should be considered because of their different efficacy and safety profiles.