Objective This study aimed to explore the changes of interhemispheric functional homotopy in patients with different course of temporal lobe epilepsy based on voxel-mirrored homotopic connectivity(VMHC).Methods Twenty temporal lobe epilepsy patients with a short disease course(TLE-SD),twenty-seven temporal lobe epilepsy patients with a long disease course(TLE-SD)and thirty healthy controls(HC)matched with demo-graphic data were enrolled.All participants finished functional MRI scans and neuropsychological assessment.Brain regions with significant changes between the TLE-SD/TLE-LD group and the healthy controls group were obtained based on the VMHC analysis,and the two-samples t-test was performed in the different brain regions of VMHC values between the two comparisons.The VMHC values of abnormal brain regions in the patient group were extracted and used for correlation analysis with the scale scores.Results Compared with HC,the VMHC values of the putamen and anterior cingulate gyrus were reduced in the TLE-SD group,while the VMHC values of the putamen,anterior cingulate gyrus,superior temporal gyrus and superior frontal gyrus were reduced in the TLE-LD group.Compared with the TLE-SD group,the VMHC values of the superior temporal gyrus in the TLE-LD group was significantly reduced(t=2.918,P=0.033).Correlation analysis showed that the VMHC values of the putamen was positively correlated with the Montreal Cognitive Assessment(MoCA)scores(r=0.442,P=0.021).Conclusions The interhemispheric functional homotopy was impaired in patients with temporal lobe epilepsy and the impairment may be more severe in patients with a long course of disease.Cognitive impairment in patients with temporal lobe epilepsy may be related to the abnormalities of interhemispheric functional homotopy.