Tauopathy contributes to cognitive decline in temporal lobe epilepsy, according to a recent study of brain tissue from 33 patients who underwent temporal lobe resection. Tau neuropil threads, neurofibrillary tangles and/or pre-tangles were found in resected tissue from 31 of the 33 patients. The patterns of tau pathology resembled those seen in Alzheimer disease and chronic traumatic encephalopathy. More-extensive tau pathology was associated with a greater decline in cognitive function in the year before surgery, and between 3 months and 1 year after surgery. These results add epilepsy to the growing list of disorders in which tau pathology contributes to neurodegeneration, and could lead to new approaches to the diagnosis and treatment of cognitive decline in epilepsy.