Objective To explore the value of conventional magnetic resonance imaging (MRI) and hydrogen proton magnetic resonance spectroscopy (1 H-MRS) in the diagnosis of hippocampal sclerosis in epileptic patients. Methods A total of 50 cases of epileptic patients who were treated in our hospital from February 2016 to November 2017 were selected, the routine MRI scan, fluid attenuated inversion recovery sequence (FLAIR), T2W-FLAIR sequence, GM-only sequence and 1 H-MRS scan were performed. Results A total of 29 cases of abnormal were detected by MRI, the detection rate was 58% and the accurate location rate was 68.97%. 41 cases of abnormal were detected by 1 H-MRS, the detection rate was 82.00%, the accurate location rate was 90.24%, and the detection rate and location accuracy of 1 H-MRS were significantly higher than that of the MRI (P<0.05). The NAA/(Cho+Cr), NAA/Cr and NAA/Cho in the affected side of the hippocampus were (0.44±0.12), (0.92±0.30) and (1.00±0.53), which were significantly lower than those in the contralateral hippocampus (P<0.05). There was no statistically significant difference in Cho/Cr between the affected side and the contralateral hippocampus (P>0.05). Conclusion MRI and 1 H-MRS has good application value in the diagnosis of hippocampal sclerosis in epileptic patients, of which 1 H-MRS detection rate and location accuracy rate are relatively high, which can quantitatively analyze brain tissue biochemical metabolism abnormalities.