Objective: The effects of bilingualism on cognitive profiles in children with pre-surgical temporal lobe epilepsy (TLE) have not been well-addressed. The goal of this systematic review was to assess the state of knowledge on cognitive performance in bilingual children with refractory TLE. Data Selection: An extensive literature search using PubMed, Wiley, and ScienceDirect/Elsevier research databases yielded 326 articles on cognitive performance of children with TLE using the following search terms: temporal lobe epilepsy in bilingual children, temporal lobe epilepsy, bilingualism, bilingual, children. Of these, only 3 met inclusion/exclusion criteria set prior to initiating the literature search. Data Synthesis: Findings from the systematic review were mixed. Although some studies found that bilingual children with refractory TLE perform similarly to healthy controls and monolingual TLE children on measures of executive functioning and working memory. Other studies found that bilingualism no longer served as a protective factor for cognitive performance, specifically executive functioning, after accounting for the presence of TLE. Conclusion: Neuropsychology is an integral part of TLE rehabilitation programs to provide comprehensive evaluations of patients with epilepsy and increase quality of life outcomes. Bilingualism may be a protective factor due to reorganization of executive functioning networks that promote cognitive reserve. However, the current review highlights the need for further study of cognitive profiles of bilingual children with TLE, as executive functioning may be uniquely impacted.