Objective To study the impact of acute postoperative seizures (APOS) on the long-term prognosis in patients with medically intractable temporal lobe epilepsy.Methods The clinical data of 52 patients with medically intractable temporal lobe epilepsy who were admitted to our hospital from June 2009 to June 2010 were retrospectively analyzed. All patients received surgery and regular postoperative follow-up in the clinic or by telephone. According to the APOS situation within one week after surgery, these patients were divided into experimental group (relapse) and control group (non-relapse). The follow-up data and long-term prognosis were compared between the two groups.Results The proportion of patients who were satisfied with seizure control was significantly lower in the experimental group than in the control group (35.0% vs 68.8%, χ²=5.683, P=0.017). According to the multivariate logistic regression analysis, relapse frequency, the dosage of anti-epileptic drug (AED) prior to surgery, postoperative electroencephalogram (EEG), and APOS that was similar to preoperative habitual seizures were independent influencing factors for the long-term prognosis.Conclusions APOS has an impact on the long-term prognosis in patients with refractory temporal lobe epilepsy. This study reveals several prognostic factors including relapse frequency, taking three or more types of AEDs prior to surgery, postoperative EEG, and APOS that is similar to preoperative habitual seizures.