The incidence of epilepsy has bimodal distribution peaking at the extremes of life. Incidence is greater in younger and older age groups (Hauser et al., 1993, Sidenvall et al., 1993, Forsgren et al., 1996, and Olafsson et al., 2005). As the world population ages more elders with epilepsy will be identified. In the high-income countries with longer life expectancy, the number of elders with epilepsy will be even higher. CPSs account for 40% of all seizure types in the elderly (Hauser et al., 1992); however, the proportion with temporal lobe epilepsy (TLE) is uncertain. 1. Causes The specific causes of TLE in the elderly have not been clearly disclosed. With advancing age underlying coexisting factors are more likely to be identified, and the proportion of people classified as idiopathic is less when compared to the younger age groups. Nonetheless, up to half of elderly patients with epilepsy go without an identified cause. In the under 65-year age group, head trauma, brain tumors, and CNS infections are common associations. Etiology of seizures veers towards a cerebrovascular origin in the elderly [6]. Dementing illnesses have also taken their place as a significant etiology [7]. Idiopathic TLE has been reported in adults with familiar history of epilepsy (mean age of onset: 25.5; range: 11–45 years). This group was also found to have a better prognosis [8]. Similar reports in elderly patients are missing. There are however case reports of mesial temporal lobe sclerosis (MTS) in elderly persons with new onset seizures. These accounts highlight the challenging differential diagnosis overlap with primary cognitive disorders and nonparaneoplastic limbic encephalitis [9]. New onset TLE has also been reported without evidence of MTS [10]. The etiology of hippocampal damage is discussed in a retrospective study of 38 patients with adult onset TLE [11]. The median age at onset was 37.8 years (range: 21.0 to 78.7 years). A total of seven patients, 60 years and older, were included in this report. In all cases, the common features encompass frequent CPSs (range <1 to 600 seizures per month) developing over one year (defined as the median time from the initial onset of seizures to the time of assessment). Based on MRI evidence of hippocampal atrophy, history of causative events, concomitant disease, cerebrospinal fluid results, and autoantibodies patients were classified in one of four etiologic categories; secondary hippocampal sclerosis (HS); idiopathic HS; definite limbic encephalitis (LE) and MRI defined possible LE. Eleven patients met secondary HS criteria.
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