objective: to investigate the pattern of perfusion abnormalities in ictal and interictal brain perfusion spect images (bsi) from patients with temporal lobe epilepsy (tle). method: it was acquired interictal and ictal bsi from 24 patients with refractory tle. bsis were analyzed by visual inspection and statistical parametric mapping (spm2). statistical analysis compared the patients group to a control group of 50 volunteers. the images from patients with left-tle were left-right flipped. results: it was not observed significant perfusional differences in interictal scans with spm. ictal bsi in spm analysis revealed hyperperfusion within ipsilateral temporal lobe (epileptogenic focus) and also contralateral parieto-occipital region, ipsilateral posterior cingulate gyrus, occipital lobes and ipsilateral basal ganglia. ictal bsi also showed areas of hypoperfusion. conclusion: in a group analysis of ictal bsi of patients with tle, voxel-wise analysis detects a network of distant regions of perfusional alteration which may play active role in seizure genesis and propagation.