Figure 6.

Central autonomic control areas and levels of interaction of autonomic control [adapted from Benarroch 2012, chapter 2 from Biaggioni’s book Primer on the Autonomic Nervous System [64]]. The central control of the sympathetic and parasympathetic nervous systems involves interconnected areas throughout the neuraxis. The central autonomic network plays a crucial role in regulating visceral functions, maintaining homeostasis, and adapting to internal and external challenges. This network operates at four hierarchical levels: spinal, bulbopontine, pontomesencephalic, and forebrain. The spinal level controls segmental reflexes, the bulbopontine level regulates circulation, respiration, and other functions, the pontomesencephalic level integrates autonomic control with pain modulation and stress responses, and the forebrain level includes the hypothalamus for integrated autonomic and endocrine responses. Additionally, components of the anterior limbic circuit in the forebrain are involved in integrating bodily sensations with emotional and goal-related autonomic responses. Sympathetic fibers are highlighted in blue, while parasympathetic fibers are highlighted in red.