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The relevance of the autonomic nervous system to neurological and psychiatric disorders

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Psychiatric and neurological conditions are recognized to be fundamentally linked to dysfunction of the central nervous system (CNS) and sensorimotor signalling. There also increasing appreciation of how cognitive, affective and motivational processes (even the representation of self) are grounded on the ...

Psychiatric and neurological conditions are recognized to be fundamentally linked to dysfunction of the central nervous system (CNS) and sensorimotor signalling. There also increasing appreciation of how cognitive, affective and motivational processes (even the representation of self) are grounded on the internal physiological state of the body, regulated neurally through actions of the autonomic nervous system (ANS). However there remains a paucity of research regarding the neural mechanisms through which the ANS shapes the expression of psychological and neurological symptoms. I propose an edition combining empirical and review papers that focuses on how ANS function influences the development maintenance and treatment of neurological and psychiatric conditions, setting out how the peripheral autonomic and central nervous system interact in different brain diseases. The objective also extends to elucidating underlying commonalities across the symptomatic expression of overtly different neurological and psychiatric conditions that can be attributed to autonomic effects. These insights will help optimize and extend existing treatment strategies.
Abnormal autonomic function is reported across neurological and neuropsychiatric disorders, from neurodegenerative disease (notably those associated with Lewy body pathology) to neurodevelopmental conditions (e.g. Tourette syndrome), and in the different expressions of demyelination, epilepsy and sleep disorders. In some cases this association is of critical importance: abnormal autonomic discharge is implicated as the key underlying mechanism in sudden unexpected death in epilepsy (SUDEP). Less well appreciated is the strong link between ANS dysfunction and psychiatric disorders. Disturbance of autonomic function is often reported as an early sign of many psychiatric disorders, intrinsic not only to anxiety disorder, but also to depression and schizophrenia In these contexts ANS dysregulation impacts on both physical health (increasing cardiovascular risk) and compromising psychological wellbeing at multiple levels via sleep disturbance, mental fatigue and dissociative symptoms. Across the board autonomic dysfunction also influence the tolerance of both medication and physiotherapy.
Convergent information regarding the central mechanisms through which normal and abnormal brain systems interact with autonomic responses in humans comes from clinical studies of focal cortical (e.g. in patients undergoing epilepsy surgery) and advanced neuroimaging. Induced or ictal discharges from temporal and frontal cortices can result in autonomic disturbances that affect arterial blood pressure, heart rate and rhythm, and cardiac neural discharge. Neuroimaging studies, largely in healthy individuals also implicate supratentorial structures in the generation, representation and integration of autonomic responses during cognitive, affective and motor behaviours. Moreover, manipulations of peripheral autonomic state impact on brain systems regulating mental and sensorimotor activity, providing insight into how the states of autonomic arousal accompanying emotional turmoil might trigger of neurological symptoms (eg. seizures in epilepsy, tics in Tourette Syndrome) as well as panic and anxiety.
This research topic will contribute to provide perspective to enhance understanding of the vital role of autonomic function in ‘brain disorders’ and will be appreciated by a wide readership of Frontiers Journals.


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