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Purpose: To show the significance of silent strokes among middle age and elderly patients having late onset epilepsy. Methods: This cross-sectional study (survey) was carried out at Rizgary Teaching Hospital, Erbil, Iraq from January to May, 2010. Patients were included in this study if they were middle aged and elderly patients (age range 50 and above) having unprovoked acquired first seizure or multiple seizures, previously or recently diagnosed as epileptic regardless the number of fits which could be single or multiple, having history of recent or old stroke or TIA and now presented with seizure. 100 Iraqi patients were included in this survey. The MRI images were examined and interpreted through collaborative discussions between a consultant Radiologist and a consultant Neurologist (T1, T2 and FLAIR sequences were obtained) and almost all patients had abnormal EEG studies. Data were tabulated and analyzed, the significance of certain parameters was measured using chi square test, p-value of ≤0.05 was considered statistically significant. Key findings: In this study males outnumber females, epilepsy was mostly observed in elderly population (70-79 years) and p value was not significant regarding sex differences in the studied sample. Silent strokes were observed mostly in elderly population (63-67%). Hypertension, hyperlipidemia, smoking, and old strokes are the commonest comorbidities observed in relation to epileptic patients with silent strokes, and partial secondary generalized epilepsy type was the commonest epilepsy variety observed (73%) followed by partial complex epilepsy (12%) and simple partial epilepsy (11%). Significance: Silent strokes were common in elderly patients having epilepsy (53%), especially patients having stroke risk factors like hypertension, and its prevalence increase with age. Silent strokes can be an indirect way to establish the causes of epilepsy in elderly population as having silent cortical ischemia.

non-epileptic patients through electroencephalography investigation and determine its relationship with certain socio-demographic and clinical characteristics. Methods: In this cross-sectional study included 400 cases (205 males and 195 females) with a mean age ± SD of 25 ± 14 years, referred to the private neurology clinic, Soran Medical Center between April 2013 and March 2017 for attacks of abnormal movements and or disturbed level of consciousness. Results: Age-related prevalence of epilepsy showed a significantly higher prevalence (P = 0.001) of the disease among those who were 20 years and more. Epileptic patients showed significantly (P = 0.001) higher sharp slow waves and sharp waves, which were mainly dominated by parietal and occipital regions of the brain. Electroencephalography finding showed higher Beta rhythm followed by Alpha and Delta rhythms (73.5%, 14.3% and 9.0%, respectively), Patients with epilepsy (generalized and focal) had shown best rhythm adoption in Beta rhythm (75.2% and 70.2%, respectively), followed by Alpha rhythm (13.2% and 14.8%, respectively). Focal to bilateral (secondary generalized) and generalized motor epilepsy were the most common diagnosis among the epileptic cases (45.4% and 43.4%, respectively). The overall sensitivity of electroencephalography was 67.8%, and specificity was 63.5%. Conclusion: The electroencephalography showed good sensitivity and specificity in diagnosing suspected epileptic patients, with interesting higher sensitivity than specificity. Not only the abnormal discharges, but the background dominating activity and the best rhythm adoption can help in the diagnosis of epilepsy.