Objective To investigate the application value of MRS in temporal lobe epilepsy (TLE) without hippocampal sclerosis.Methods A retrospective study was conducted in 23 unilateral TLE patients (TLE group) with absence of hippocampal sclerosis and 20 age-matched normal control subjects (control group).All of them underwent conventional MRI and MRS.N-acetyl aspartate (NAA)/creatine (Cr),choline (Cho)/Cr ratios of bilateral hippocampus in 2 groups were analyzed.Eleven of 23 patients underwent surgical treatment,pathological findings and surgical outcomes were evaluated.Results The NAA/Cr ratios of ipsilateral hippocampus significantly decreased compared with that in the contralateral hippocampus (t=-7.97,P＜0.001) and the control group (t=-9.96,P＜0.001).There was no significant difference between the contralateral hippocampus in patients and the control group (t=-1.21,P=0.12).The Cho/Cr ratios of ipsilateral hippocampus in TLE had no significant difference compared with contralateral hippocampus (t=0.50,P=0.31) and the control group (t=-0.59,P=0.28).The pathological findings of the 11 patients who underwent temporal lobe resection indicated small amounts of neuronal loss and unobvious gliosis.Conclusion MRS is helpful in clinical practice to lateralize and localize the epileptogenic foci in the absence of hippocampal sclerosis in patients with TLE.