Clinical Autonomic Research

, Volume 29, Issue 2, pp 137–150 | Cite as

Epidemiology and pathophysiology of autonomic seizures: a systematic review

  • Christoph BaumgartnerEmail author
  • Johannes Koren
  • Martha Britto-Arias
  • Simone Schmidt
  • Susanne Pirker
Review Article



To review the epidemiology and pathophysiology of autonomic symptoms and signs during epileptic seizures.


We performed a systematic literature search on the following autonomic symptoms and signs during epileptic seizures: cardiovascular changes, respiratory manifestations, gastrointestinal symptoms, cutaneous manifestations, sexual and genital manifestations, and urinary symptoms.


Autonomic symptoms and signs can represent the predominant symptom at the onset of a focal seizure, which would then lead to the seizure being classified as a focal onset autonomic seizure. Conversely, clinically relevant autonomic symptoms and signs frequently accompany seizures of focal, generalized, and/or unknown onset, but the seizure is regardless classified according to other, more relevant features. Autonomic symptoms and signs do not represent mere reactions to motor activity or other behavioral seizure manifestations, but rather they are generated by epileptic discharges affecting the central autonomic network. We have reviewed the localizing and lateralizing information currently available on the seizure onset zone and on seizure propagation pathways as provided by systematic analysis of specific autonomic seizure symptoms and signs. We present data on how autonomic seizure symptoms and signs are useful for gaining a better understanding of the anatomical and functional organization of the central autonomic network. Finally, we discuss the differential diagnosis of focal autonomic seizures with autonomic symptoms and signs representing the sole seizure manifestation versus various non-epileptic conditions.


Autonomic seizure symptoms and signs are relevant in clinical epileptology and open a unique window on the functional organization and pathophysiology of the central autonomic network.


Epilepsy Seizures Autonomic Semiology 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Christoph Baumgartner
    • 1
    • 2
    • 3
    Email author
  • Johannes Koren
    • 1
    • 2
  • Martha Britto-Arias
    • 1
  • Simone Schmidt
    • 1
    • 2
  • Susanne Pirker
    • 1
    • 2
  1. 1.Department of NeurologyGeneral Hospital Hietzing–Neurological Center RosenhügelViennaAustria
  2. 2.Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive NeurologyViennaAustria
  3. 3.Medical FacultySigmund Freud UniversityViennaAustria

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