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The aim of the present study was to review the current knowledge on the neuropathological spectrum of late onset epilepsies. Several terms including ‘neuropathology*’ AND ‘late onset epilepsy’ (LOE) combined with distinct neuropathological diagnostic terms were used to search PubMed until November 15, 2023. We report on the relevance of definitional aspects of LOE with implications for the diagnostic spectrum of epilepsies. The neuropathological spectrum in patients with LOE is described and includes vascular lesions, low-grade neuroepithelial neoplasms and focal cortical dysplasias (FCD).