ABSTRACT
Seizures can weakly or profoundly impact autonomic nervous system (ANS) function. Seizure spread from limbic or neocortical regions through various subcortical structures including hypothalamus and medullary centers impacts sympathetic and parasympathetic divisions to cause diverse systemic effects, including pupillary constriction or dilation, salivation, piloerection, diaphoresis, changes in cardiac rhythm, derangements of peristalsis, and urinary incontinence (Van Buren 1958; Baumgartner et al. 2001; Devinsky 2004). Significant autonomic effects of seizures more commonly occur in association with generalized tonic-clonic seizures or partial seizures originating in the temporal lobe (Opherk et al. 2002; Leutmezer et al. 2003; Devinsky 2004) than in association with absence seizures or focal seizures that minimally impact limbic or insular cortices. The severity of some autonomic effects of seizures makes seizure-induced autonomic derangements and the resulting consequences popular candidates for consideration as contributing to or causing sudden unexpected death in epilepsy (SUDEP) (Lathers et al. 2008; Sakamoto et al. 2008; Devinsky 2011; Stewart 2011; Surges and Sander 2012; Tolstykh and Cavazos 2013).
