Novelty processing depends on medial temporal lobe structures

•The role of the medial temporal lobe (MTL) in novelty processing was investigated.•Epilepsy patients with MTL resections and controls performed a novelty oddball task.•Novelty processing (the N2 and N2-P3) was reduced in patients compared to controls.•The P3 was smaller for novels presented contra- versus ipsilateral to the resection.•Target processing was unaffected by the MTL resections. The goal of the present study was to identify the role of the medial temporal lobe (MTL) in the detection and later processing of novelty. Twenty-one epilepsy patients with unilateral MTL resection (10 left-sided; 11 right-sided) and 26 matched healthy controls performed an adapted visual novelty oddball task. In this task two streams of stimuli were presented on the left and right of fixation while the patients’ electroencephalogram was measured. The participants had to respond to infrequent target stimuli, while ignoring frequent standard, and infrequent novel stimuli that were presented to the left or right, appearing either contra- or ipsilateral to the patients’ resections. Novelty detection, as indexed by the N2 ERP component elicited by novels, was reduced by the MTL resections, as evidenced by a smaller N2 for patients than healthy controls. Later processing of novels, as indexed by the novelty P3 ERP component, was reduced for novels presented contra- versus ipsilateral to the resected side. Moreover, at a frontal electrode site, the N2-P3 complex showed reduced novelty processing in patients with MTL resections compared to healthy controls. The ERP differences were specific for the novel stimuli, as target processing, as indexed by the P3b, was unaffected in the patients: No P3b differences were found between targets presented ipsi- or contralaterally to the resected side, nor between patients and healthy controls. The current results suggest that MTL structures play a role in novelty processing. In contrast, target processing was unaffected by MTL resections.