Anatomical and functional neuroimaging studies have had a significant impact on the management of patients with epilepsy, particularly in the pre-surgical evaluation of patients with medically refractory partial seizures. Magnetic resonance spectroscopy (MRS) has come to recent attention as a tool with potential to aid in the evaluation of patients with epilepsy, to study the pathophysiology of seizures, and to predict outcomes after medical and surgical treatments of epilepsy.  Proton (¹H) MRS studies have demonstrated localized reductions in N-acetylaspartate (NAA) in patients with temporal lobe epilepsy and in patients with seizures of extratemporal origin, which correlate with the severity of neuronal loss or dysfunction in the epileptogenic region.  Phosphorus (³¹P) MRS has demonstrated increased inorganic phosphates (Pi), a reduction in phosphomonoesters (PME), and interictal tissue alkalosis ipsilateral to the site of seizure onsets.  Metabolic changes seen with MRS frequently extend outside the seizure focus, suggesting a more widespread disturbance of cerebral function in the brains of patients with epilepsy and potentially explaining some of the variability in treatment outcomes.  In conjunction with clinical data, MRS can be useful in supporting the lateralization and, to some extent, the localization of seizure foci, even in the absence of abnormality on conventional neuroimaging studies.  This technique has the potential to add to the presurgical evaluation of patients with refractory partial seizures and possibly to help predict outcomes.