Ictal and peri-ictal heart rate (HR) abnormalities in 20 children and adolescents with medically refractory symptomatic temporal lobe epilepsy (TLE) were investigated at the University Hospital Vienna, Austria. None had a known cardiac abnormality, and all were at rest in bed during EKG and EEG long-term monitoring. Of 72 TLSs analyzed, ictal tachycardia occurred in 71 (98%), and ictal bradycardia was not observed. In pre-ictal stages, tachycardia occurred in 20 seizures and mild bradycardia in 3. Tachycardia persisted >60 seconds after EEG seizure termination in 44 seizures (62%). Rhythm and conduction abnormalities, including bradycardia, extreme HR oscillation, and premature ventricular beats, occurred in the postictal period during some complex partial TLSs. Early and high HR increase was associated with right mesial TLSs. The results confirm a right hemispheric lateralization of sympathetic cardiac regulation. 
COMMENT. Ictal tachycardia is the most frequent cardiac irregularity associated with complex partial seizures, occurring especially with epileptiform discharges lateralized to the right temporal lobe. It is suggested that EKG abnormalities and cardiac dysregulation during symptomatic temporal lobe epilepsy may contribute to the mechanism of sudden unexplained death.
The effect of hippocampal sclerosis on cardiovascular autonomic regulation was studied in 8 TLE patients with and 31 without hippocampal sclerosis (HS), using cardiovascular reflex tests and spectral analysis of 24-h ECG recordings, at University of Oulu, Finland. Compared to controls, a diminished heart rate variability (HRV) was observed in patients with, or without HS. Functional rather than structural changes are important in the altered cardiovascular regulation in patients with TLE.