The relationships of medical, developmental, social, and familial variables to intellectual performances (IQ scores) were assessed in a sample of 242 adult patients with intractable lateralized temporal lobe epilepsy. Lower IQ scores were associated with low patient and parent education. In addition to the significant contributions of nonneurological social and familial factors to IQ, early age at onset of regular seizures and presence of primary neurological dysfunction in the left cerebral hemisphere were also both independently related to lower IQ. The obtained results suggest that the occurrence of regular seizures during a critical period in early childhood neural maturation poses the greatest risk to cognitive development in the epilepsy population. Total duration of seizures, history of severe convulsive episodes, and the occurrence of another nonepileptic neurological problem in early childhood do not contribute significantly to delayed cognitive development.