The new onset of epilepsy in the elderly population and its prevalence of acute provoked and unprovoked seizures, epilepsy and status epilepticus are higher compared to the younger population. Its pharmacotherapy considerations in a study reveal that early treatment in elderly patients results in higher chances of seizure freedom compared to younger patients. Monotherapy is considered as the preferred choice of treatment to minimise side effects and drug-to-drug interaction. A study described clinical characteristics of ASM monotherapy in the elderly population with new-onset epilepsy. 56.7% of patients with monotherapy achieved one year of seizure freedom with the early-stage outcomes. 79.8% of patients achieved seizure freedom with monotherapy (median follow-up = 42 months) with long-term treatment outcomes. The initial treatment with ASM Monotherapy in the elderly population aids in achieving early seizure freedom.