... occur because of involvement of several critical pathways of autonomic nervous system, including the brain stem, spinal cord, hypothalamus and cerebral cortex. Demyelinating plaques may disrupt ... reflex pathways in the insular, cingulated and ventromedial prefrontal cortices, central nucleus of the amygdala, paraventricular hypothalamus and the medulla. In addition there can be interference ... cardiovascular reflex testing it has been shown that both sympathetic as well as parasympathetic dys-function can occur in patients with MS (12-16). Re-duced heart rate variability and vasomotor...