Background: epileptic patients suffer from many autonomic symptoms either during the seizure or in between seizures. Interictal autonomic cardiac changes may cause arrhythmia which may be life threatening. Aim of the work: to recognize the presence of cardiac autonomic changes in patients with temporal lobe epilepsy and to find the relation between autonomic cardiac changes and different variables. Patients and methods: Twenty patients with well controlled TLE and twenty patients with uncontrolled TLE were subjected to standard 12-lead ECG and 24 hour holter ECG. Results: QTc was significantly shorter in patients with uncontrolled TLE than in patients with well controlled TLE. Patients with uncontrolled TLE had a faster heart rate than patients with well controlled TLE. Patients with uncontrolled TLE showed significant less SDNN, rMSSD and PNN50 than those with well controlled seizures.On the other hand, LF and LF/HF ratio was significantly more in uncontrolled group than the controlled group. Conclusion: There is an interictal alteration in autonomic control of the heart in TLE. This alteration is corrected with proper control of seizures