Temporal lobe epilepsy (TLE) is the most common type of epilepsy in adults. The literature in this field supports the notion than many patients become candidates for surgery and little is known about the group of patients who do not require surgical treatment. This is a retrospective cohort study that included all patients with TLE assessed and followed by the Saskatchewan Epilepsy Program since 2007. Mild course was defined as patients not having seizures, using or not AEDs at last follow up. Severe course of TLE was considered in patients with continuous seizures and patients who had epilepsy surgery. Descriptive statistics were used. OR and CI were calculated. One hundred and fifty nine patients were included. Age of patients at last follow up was 46.04 + 14.4 (range 19-88) years. Mean follow up of patients was 43.46+ 22.6 (6 to 84) months. Fourth six patients (29%) were seizure-free with AEDS (mild course TLE) and 113 (61%) had severe course of TLE. Patients with mild course of TLE were older (p 0.002), with a late onset of epilepsy (p< 0.001) and their epilepsy evolution was shorter (p<0.001). Our study shows that not all the patients with TLE require surgery and that a fair percentage of patients can be controlled with medication.