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Updated: Jun 15, 2026

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity
Published on: January 10, 2013
Periaqueductal gray control of breathing
Hari H Subramanian1, Gert Holstege
1University of Groningen, UMCG, Center for Uroneurology, 9700RB Groningen, The Netherlands. h.h.subramanian@med.umcg.nl
Abstract:
Change of the basic respiratory rhythm (eupnea) is a pre-requisite for survival. For example, sudden escape from danger needs rapid shallow breathing, strenuous exercise requires tachypnea for sufficient supply of oxygen and a strong anxiety reaction necessitates gasping. Also for vocalization (and for speech in humans) an important mechanism for survival, respiration has to be changed. The caudal brainstem premotor respiratory centers need input from higher brain centers in order to change respiration according to the surrounding circumstances. One of the most important of such a higher brain centers is the midbrain periaqueductal gray (PAG). The PAG co-ordinates motor output, including respiratory changes based on input from limbic, prefrontal and anterior cingulate cortex regions. These areas integrate visual, auditory and somatosensory information in the context of basic survival mechanisms and relay the result to the PAG, which has access to respiratory control centers in the caudal brainstem. Through these pathways the PAG can change eupneic respiratory rhythm into the behavior necessary for that specific situation. We present data obtained from the cat and propose a functional framework for the breathing control pathways.
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