OBJECTIVE Functional near-infrared spectroscopy (fNIRS) is a technique that allows continuous non-invasive monitoring of tissue oxygenation and haemodynamics in the brain. By using combined EEG-fNIRS recordings, we sought to better understand the pathophysiology of temporal lobe seizures. RESULTS Nine patients (5 males; mean age 35 years; range 11-56 years) with refractory mesial temporal lobe epilepsy underwent combined EEG-fNIRS recordings. Eight complex partial seizures from 3 patients were successfully recorded. All seizures were associated with significant local and remote haemodynamic changes which outlasted the duration of seizures. Over the epileptogenic temporal lobe, increased oxygenation [increase in cerebral blood volume (CBV) and oxyhaemoglobin (HbO), decrease in deoxyhaemoglobin (HbR)] was followed by a deoxygenated state [increase in HbR]. A similar haemodynamic profile was seen over the contralateral temporal lobe (even without evidence of epileptic propagation) though variations generally had lower amplitudes. Heterogeneous haemodynamic changes in remote frontal and/or parietal areas were also noted early on when epileptic activity was limited to the temporal lobe. CONCLUSIONS EEG-fNIRS reveals complex local and remote oxygenation changes during temporal lobe seizures.