The Paradox of the Parasympathetic in Amyotrophic Lateral Sclerosis. Vagus Nerve, Inflammation, and Possibilities for Therapeutic Collaboration through Integrative Psychoneurosomatics

Amyotrophic Lateral Sclerosis (ALS) is now recognized as a multisystem neurodegenerativedisease involving the immune system, energy metabolism, the neuroendocrine axis, and theautonomic nervous system. This article explores the role of the parasympathetic nervoussystem and the vagus nerve in ALS, highlighting a clinical and biological paradox: the sys-tem responsible for containing stress and inflammation is one of the most vulnerable in thedisease. After a synthesis of the cholinergic anti-inflammatory pathway and the evidenceon parasympathetic dysfunction in ALS, the article proposes a regulatory support approach— integrative psychoneurosomatics — with realistic objectives that do not replace neuro-logical medicine: improving quality of life, reducing the neurophysiological stress load, andsupporting the patient’s active collaboration with the medical team. The limitations of theapproach, the psychological implications of dysautonomia, and the notion of realistic hopeare discussed. The article does not propose alternative therapies or promises of slowing thedisease, but rather regulatory strategies to be integrated into multidisciplinary care.