Background: Up to 30% of patients with temporal lobe epilepsy (TLE) have no identifiable risk factors. Objectives: To report nine patients with TLE who had a history of eclampsia as the only risk factor for epilepsy and to investigate whether this possible association existed in a larger cohort of women with surgically treated TLE. Methods: The clinical data, video-EEG, neuroimaging, and neuropathology of 195 consecutive women undergoing anterior temporal lobectomy (ATL) were reviewed. Risk factors for TLE, age at epilepsy onset, and occurrence of pregnancy were identified in each patient. Results: Twenty-six women had no identifiable risk factors or seizures following a pregnancy. Nine of the 26 women had a history of eclampsia. The median age at the time of eclampsia was 16 years, and the latent period between the occurrence of eclampsia and onset of epilepsy ranged from 1 month to 2 years. The clinical, EEG, MRI, and neuropathologic findings were typical of hippocampal sclerosis (HS) and other than age at onset were no different from those of noneclampsia ATL patients. At mean follow-up of 57 months, seven patients were seizure-free and the other two markedly improved. Conclusion: Eclampsia may be a risk factor for TLE and HS.