Assessing epilepsy-related autonomic manifestations: Beyond cardiac and respiratory investigations

The Autonomic Nervous System (ANS) regulates many critical physiological functions. Its control relies on cortical input, especially limbic areas, which are often involved in epilepsy. Peri-ictal autonomic dysfunction is now well documented, but inter-ictal dysregulation is less stud-ied. In this review, we discuss the available data on epilepsy-related autonomic dysfunction and the objective tests available. Epilepsy is associated with sympathetic-parasympathetic imbalance and a shift towards sympathetic dominance. Objective tests report alterations in heart rate, bar-oreflex function, cerebral autoregulation, sweat glands activity, thermoregulation, gastrointesti-nal and urinary function. However, some tests have found contradictory results and many tests suffer from a lack of sensitivity and reproducibility. Further study on interictal ANS function is required to further understand autonomic dysregulation and the potential association with clini-cally-relevant complications, including risk of Sudden Unexpected Death In Epilepsy (SUDEP).(c) 2023 Elsevier Masson SAS. All rights reserved.