We conducted MR volumetry and voxel-based morphometry in 19 patients who had idiopathic generalized epilepsy (IGE) with tonic clonic seizures as the only seizure type and 52 control subjects. Patients exhibited elevated frontal lobe fraction of CSF and reduced fraction of gray matter in the frontal, parietal, temporal cortex, thalamus, and cerebellum. The thalamus and cerebellum also showed reduced volumes, as did the caudate and putamen. Contrary to current diagnostic criteria, regional tissue abnormalities may be present in IGE.