Epilepsy is a group of chronic neurologic disorders characterized by epileptic seizures. Epileptic seizures are abnormal, excessive, synchronous neural discharges resulting in motor and/or sensory manifestations. One of the main characteristics of epilepsy is stereotyped manifestation, meaning that the epileptic discharges are always spreading out of the same region of the brain and in the same way, leading to always the same phenomenology of the seizures and EEG findings. Diagnostic and treatment of epilepsy are long lasting and complex and need to be individualized. By increasing life expectancy, the incidence of epilepsy in elderly is also increasing. In the past, epilepsy was considered to be a childhood disease, but due to the demographic transition and minorization of the exposure to risk factors, in the past few decades the incidence of the epilepsy in developed countries is the highest among elderly. Multiple comorbidities that are rule in this age group more than an exception, administration of multiple different drugs at the same time, changed pharmacodynamics and pharmacokinetics of the drugs and low compliance of the patients represent the challenges of today’s diagnostic and treatment of epilepsy in elderly and require multimodal and individualized access to the patient.