If a patient has no history of epilepsy but begins to experience epileptic seizures in old age, it is generally secondary epilepsy, also known as symptomatic epilepsy. All patients should have a clear cause, but with current diagnostic techniques, it is not always possible to find the cause. If the cause cannot be identified, it is called cryptogenic epilepsy. In such cases, it is generally necessary to improve diagnostic methods, such as cranial magnetic resonance imaging (MRI) and cranial magnetic resonance angiography. The most common causes of epilepsy in the elderly are generally cerebrovascular disease, brain trauma, or encephalitis, and in some cases, brain tumors. Any disease that causes brain cell damage can potentially cause symptomatic epileptic seizures. If all imaging examinations fail to reveal any abnormalities, regular follow-ups are necessary to monitor for early-stage tumors that may not be detectable on imaging tests. Meanwhile, antiepileptic treatment should be administered, and routine blood tests, liver, and kidney functions should be regularly monitored.