Older people face special challenges in living with and adjusting to epilepsy and seizures. Epilepsy in elderly people is one of the underestimated health problems in Egypt. Objectives: To estimate the prevalence of epilepsy in elderly people in Al Quseir city- Red Sea Governate, Egypt and to estimate its magnitude of treatment gap. Methods: The study was a part of door to door study, including every door to screen all inhabitants in Al-Quseir city (33,818 inhabitants); by 3 specialists of neurology and 15 female social workers. Number of people ≥ 60 years is 2106 persons among whom we detected 13 cases with epilepsy. All suspected cases were subjected to detailed history, clinical examination, EEG, Neuroimaging studies. Results: The study revealed that life time prevalence of epilepsy is 6.2/1000, with highest peak during the eighth decade of life, while the prevalence of active epilepsy is 2.4/1000 population. The prevalence rate of epilepsy in elderly males is double that in elderly females. Epilepsy in elderly detected in this study is caused by symptomatic cause (30%, n=4), idiopathic (53.8%, n=7), and cryptogenic (15.4%, n=2). The annual incidence rate is 142.4/100,000. Focal epilepsy is the most frequently encountered type (84.6%). The treatment gap of epilepsy in elderly in Al Quseir city is 80%. Conclusion: epilepsy among elderly is an underestimated health problem in Egypt and treatment gap is high which necessitates developing health services in this locality.