AbstractObjectiveElectroencephalographic (EEG) microstate abnormalities have been documented in different neurological disorders. We aimed to assess whether EEG microstates are altered also in patients with temporal epilepsy (TLE) and whether they show different activations in patients with unilateral TLE (UTLE) and bilateral TLE (BTLE).MethodsNineteen patients with UTLE, 12 with BTLE, and 15 healthy controls were enrolled. Resting state high‐density electroencephalography (128 channels) was recorded for 15 min with closed eyes. We obtained a set of stable scalp maps representing the EEG activity, named microstates, from which we acquired the following variables: global explained variance (GEV), mean duration (MD), time coverage (TC), and frequency of occurrence (FO). Two‐way repeated measures analysis of variance was used to compare groups, and Spearman correlation was performed to study the maps in association with the clinical and neuropsychological data.ResultsPatients with BTLE and UTLE showed differences in most of the parameters (GEV, MD, TC, FO) of the four microstate maps (A–D) compared to controls. Patients with BTLE showed a significant increase in all parameters for the microstates in Map‐A and a decrease in Map‐D compared to UTLE and controls. We observed a correlation between Map‐A, disease duration, and spatial short‐term memory, whereas microstate Map‐D was correlated with the global intelligence score and short‐term memory performance.SignificanceA global alteration of the neural dynamics was observed in patients with TLE compared to controls. A different pattern of EEG microstate abnormalities was identified in BTLE compared to UTLE, which might represent a distinctive biomarker.