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A successful treatment of epilepsy depends on numerous factors such as etiology, genetics and environmental impact. An exact diagnosis, treatment and an adequate selection of antiepileptic drugs (AED) are important from the very beginning. The patient with symptomatic epilepsy caused by the brain tumor (low-grade astrocytoma in the left parietal lobe, surgically removed 17 years after the first manifestation of illness) is presented in this study. He has been seizure free for 6 years. The represented case study deals with the risk-benefit analysis of the discontinuation of the prescribed antiepileptic treatment that has lasted for 23 years.

Epilepsies in the elderly are generally considered to be those occurring after the age of 60 or 65. Epilepsy that manifests for the first time in adult age is considered a late-onset epilepsy. The majority of seizures are partial with or without secondary generalization. The most important risk factors for epilepsy in the elderly are head traumas, strokes, tumour, Alzheimer's disease and other types of dementia, encephalitis, arterial hypertension and cardiac insufficiency, as well as alcohol and drug abuse. Depression is the most common psychiatric comorbidity in patients with epilepsy. The relationship between depression and epilepsy is bidirectional suggesting that common pathogenic mechanisms are shared by the two disorders. Symptoms of depression can manifest in preictal period, as actual seizures, and in postictal period. However, interictal depression is the most common presentation. Iatrogenic causes, especially treatment with some antiepileptics must be excluded. Although sometimes the diagnostic criteria of DSM-IV are not completely met, the patients generally present with symptoms of a chronic course depression interrupted by recurrent symptom-free periods lasting from several hours to several days. The negative impact of depression on patients’ life quality of is well known and causes various psychosocial problems. Therefore, its early detection is of paramount importance. The management of depression in elderly with epilepsy is very specific due to pharmacokinetic interactions between antidepressant drugs and antiepileptics. The aim of our work is to establish and present the differences in the use of the antiepileptic drugs (AEDs) in treatment of older patients with epilepsy and depression. Data on patient demographics, type of epilepsy, seizure frequency and drug therapy for epilepsy and mental disorders are also discussed herein.