PURPOSE: Seizures are known to affect diverse areas of the Central Autonomic Network (CAN) resulting in varied autonomic symptoms. The objectives of the study were to characterize neuro-cardiac autonomic regulation in hot water epilepsy (HWE) with or without spontaneous seizure, and to analyze the effect of Carbamazepine (CBZ). METHODS: Seventy patients of HWE [42 drug-naive \'HWE only\' and 28 \'HWE with spontaneous complex partial seizure (CPS),\' on CBZ] and 40 spontaneous CPS on CBZ were recruited after informed consent. Fifty healthy volunteers served as control. Conventional cardiac autonomic function tests, Heart Rate Variability (HRV), Blood Pressure Variability (BPV), and baroreflex sensitivity (BRS) were performed. RESULTS: Significant dysfunction was evidenced in most of the autonomic function parameters in all the epilepsy subgroups when compared with controls. Significant reduction in the parasympathetic activity in HWE patients was observed. Significant impairment of short-term fluctuation of blood pressure in \'HWE with spontaneous CPS\' compared to \'healthy volunteers\' was detected. Compared to \'HWE only\', \'HWE with spontaneous CPS\' showed impaired sympathovagal balance. The BRS were also altered in \'HWE with spontaneous CPS\' compared to \'HWE only\'. The comparison of \'spontaneous CPS\' with \'HWE with spontaneous CPS\' and \'HWE only\' showed reduced parasympathetic and sympathetic activities. CONCLUSION: Both cardiovascular reflexes and autonomic cardiovascular regulation were altered in HWE, more so in \'HWE with spontaneous seizures\'. Compared to those on CBZ, drug naive had severe effect on vagal tone and CBZ did not alter cardiac autonomic functions in reflex as well as in non-reflex epilepsies.