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We reviewed relevant <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> publications including those involving human subjects with seizures. <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> has been studied in patients with epilepsy for more than 30\u00a0years and, overall, patients with epilepsy display altered interictal <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content>, suggesting a shift in autonomic balance toward sympathetic dominance. This derangement appears more severe in those with temporal lobe epilepsy and drug\u2010resistant epilepsy. Normal diurnal variation in <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> is also disturbed in at least some people with epilepsy, but this aspect has received less study. Some therapeutic interventions, including vagus nerve stimulation and antiepileptic medications, may partially normalize altered <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content>, but studies in this area are sometimes contradictory. During seizures, the changes in <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> may be complex, but the general trend is toward a further increase in sympathetic overactivity. Research in <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> in people with epilepsy has been limited by inconsistent experimental protocols and studies that are often underpowered. <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> measurement has the potential to aid clinical epilepsy management in several possible ways. <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> may be useful in predicting which patients are likely to benefit from surgical interventions such as vagus nerve stimulation and focal cerebral resection. As well, <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> could eventually have utility as a biomarker of risk for sudden unexpected death in epilepsy (SUDEP). However, at present, the inconsistent measurement protocols used in research are hindering translation into clinical practice. A minimum protocol for <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> evaluation, to be used in all studies involving epilepsy patients, is necessary to eventually allow <jats:styled-content style=\"fixed-case\">HRV<\/jats:styled-content> to become a useful tool for clinicians. We propose a straightforward protocol, involving 5\u2010minute measurements of root mean square of successive differences in wakefulness and light sleep.<\/jats:p>","DOI":"10.1111\/epi.14587","type":"journal-article","created":{"date-parts":[[2018,10,22]],"date-time":"2018-10-22T05:35:03Z","timestamp":1540186503000},"page":"2169-2178","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":107,"title":["Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7831-4593","authenticated-orcid":false,"given":"Kenneth A.","family":"Myers","sequence":"first","affiliation":[{"name":"Research Institute of the McGill University Health Centre Montreal Quebec Canada"},{"name":"Division of Child Neurology Department of Pediatrics Montreal Children's Hospital McGill University Health Centre Montreal Quebec 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