Fig. 1

Simplified schematic of pathways from cortical regions to the brainstem to influence autonomic outflow. Adapted from [105] with permission. Lines denote bidirectional connections, and arrows denote monodirectional projections. The key point is that pathways exist for seizure spread from limbic cortical areas (via subiculum) to hypothalamus (including paraventricular nucleus, PVN) and to brainstem regions serving as parasympathetic motor and sympathetic premotor functions. Relayed projections through the amygdala are even more prominent. Projections from neocortical regions, including insular cortex, have their own access to the hypothalamus and brainstem nuclei. The result is a multitude of pathways for seizure spread to impact autonomic and respiratory brainstem regions. NTS nucleus of the tractus solitarius, RVLM rostral ventrolateral medulla