Epilepsy occurs in a bimodal pattern with peak incidences during the first year of life and in the ageing population. People aged over 70 have the highest incidence of epilepsy. Physicians, however, are often not aware this prevalence in the elderly. Diagnosis and treatment of epilepsy in the ageing are usually more complicated than in the younger population as there are age-related physiologic changes, multiple pathologies and medical problems as well as polypharmacy. Moreover, older patients are usually vulnerable to adverse drug reactions. This article reviews differences in various aspects of epilepsy between older and younger patients, physiological ageing changes affecting the use of antiepileptic drugs in the elderly and choice of drug treatment in this population.