Patients with chronic epilepsy, who have suffered a high number of secondarily generalized tonicclonic seizures (SGTCS) frequently show cognitive comorbidity. It is yet unclear whether a higher number of SGTCS is associated with tissue changes in the brain. We have investigated in patients with chronic epilepsy whether a high number of SGTCS accumulated over life is associated with microstructural changes in brain tissue. Sixteen patients with localization-related epilepsy with SGTCS underwent a multimodal quantitative Magnetic Resonance (MR) examination at 1.5 T, comprising T2 relaxometry, and diffusion weighted imaging to study microstructural changes in the temporal and frontal lobes. Fourteen healthy volunteers were also included to assess the effect of age. Patients with more than 20 SGTCS (n=8) showed a significantly lower IQ (-20%, p<0.05) compared to those with less than 20 SGTCS (n=8). Furthermore, regional combined multimodal analysis revealed that significant quantitative MRI changes, related to the number of SGTCS, were present in the frontal lobe but not in the temporal lobe. Moreover, the left and right frontal lobe generally displayed lower T2 relaxation times, smaller pericortical cerebrospinal fluid fraction and lower apparent diffusion coefficients, in the patients with more than 20 SGTCS. These findings suggest that SGTCS are associated with substantial changes in microstructural brain tissue characteristics within the frontal lobes. These frontal changes possibly explain the cognitive problems which are often observed in patients with many SGTCS. This knowledge may help in the development of treatment aimed at preventing decline in cognitive abilities.