[Epilepsy and Autonomic Nervous System]

Epileptic activity that involves the central autonomic system, including the insular lobe, medial prefrontal cortex, amygdala, hypothalamus, periaqueductal gray, parabrachial complex, nucleus tractus solitarius, and ventrolateral medulla results in seizures with various autonomic manifestations. Some autonomic manifestations suggest localization and lateralization of epileptic foci. The autonomic nervous system modulates cerebral activity under physiological and pathological conditions. Vagus nerve stimulation (VNS) has attracted much attention for treatment of various neurological and psychiatric disorders and is an established palliative care strategy for patients with medically intractable epilepsy. Clinical and experimental studies suggest that VNS stabilizes cerebral cortical activity and inhibits abnormal excitability via pathways including upward vagus nerve conduction, nucleus tractus solitarius, and the thalamus, which consequently produces an anti-epileptic effect.