Skip to main content
PMC home page
Neurotherapeutics logoLink to Neurotherapeutics
. 2009 Apr;6(2):415–420. doi: 10.1016/j.nurt.2008.12.004

Botanicals and herbs: A traditional approach to treating epilepsy

Steven C Schachter 1,✉
PMCID: PMC5084222  PMID: 19332338

Summary

Botanicals and herbs have a centuries-old tradition of use by persons with epilepsy, in many cultures around the world. At present, herbal therapies are tried by patients in developing as well as developed countries for control of seizures or adverse effects from antiepileptic drugs (AEDs), or for general health maintenance, usually without the knowledge of physicians who prescribe their AEDs. Well-designed clinical trials of herbal therapies in patients with epilepsy are scarce, and methodological issues prevent any conclusions of their efficacy or safety in this population. Furthermore, some botanicals and herbs may be proconvulsant or may alter AED metabolism. In spite of these limitations, further preclinical evaluation of botanicals and herbs and their constituent compounds using validated scientific methods is warranted based on numerous anecdotal observations of clinical benefit in patients with epilepsy and published reports showing mechanisms of action relevant to epilepsy or anticonvulsant effects in animal models of epilepsy. This review highlights the use of herbal therapies for epilepsy, outlines the role of the U.S. Food and Drug Administration in regulating herbal products, and presents the author’s approach to the scientific assessment of herbal therapies as potential therapies for patients with epilepsy.

Key Words: Epilepsy, herbal medicine, botanical, dietary supplement, complementary and alternative therapies, huperzine A

References

  • 1.Brodie MJ. Diagnosing and predicting refractory epilepsy. Acta Neurol Scand Suppl. 2005;181:36–39. doi: 10.1111/j.1600-0404.2005.00507.x. [DOI] [PubMed] [Google Scholar]
  • 2.Meinardi H, Scott RA, Reis R, Sander JW, ILAE Commission on the Developing World The treatment gap in epilepsy: the current situation and ways forward. Epilepsia. 2001;42:136–149. doi: 10.1046/j.1528-1157.2001.32800.x. [DOI] [PubMed] [Google Scholar]
  • 3.Wahner-Roedler DL, Elkin PL, Vincent A, et al. Use of complementary and alternative medical therapies by patients referred to a fibromyalgia treatment program at a tertiary care center. Mayo Clin Proc. 2005;80:55–60. doi: 10.4065/80.1.55. [DOI] [PubMed] [Google Scholar]
  • 4.Liow K, Ablah E, Nguyen JC, et al. Pattern and frequency of use of complementary and alternative medicine among patients with epilepsy in the midwestern United States. Epilepsy Behav. 2007;10:576–582. doi: 10.1016/j.yebeh.2007.02.017. [DOI] [PubMed] [Google Scholar]
  • 5.Easterford K, Clough P, Comish S, Lawton L, Duncan S. The use of complementary medicines and alternative practitioners in a cohort of patients with epilepsy. Epilepsy Behav. 2005;6:59–62. doi: 10.1016/j.yebeh.2004.10.007. [DOI] [PubMed] [Google Scholar]
  • 6.Peebles CT, McAuley JW, Roach J, Moore JL, Reeves AL. Alternative medicine use by patients with epilepsy. Epilepsy Behav. 2000;1:74–77. doi: 10.1006/ebeh.2000.0031. [DOI] [PubMed] [Google Scholar]
  • 7.Sirven JI, Drazkowski JF, Zimmerman RS, Bortz JJ, Shulman DL, Macleish M. Complementary/alternative medicine for epilepsy in Arizona. Neurology. 2003;61:576–577. doi: 10.1212/01.wnl.0000073541.08356.47. [DOI] [PubMed] [Google Scholar]
  • 8.Rhodes PJ, Small N, Ismail H, Wright JP. The use of biomedicine, complementary and alternative medicine, and ethnomedicine for the treatment of epilepsy among people of South Asian origin in the UK. BMC Complement Altern Med. 2008;8:7–7. doi: 10.1186/1472-6882-8-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Harms SL, Garrard J, Schwinghammer P, Eberly LE, Chang Y, Leppik IE. Ginkgo biloba use in nursing home elderly with epilepsy or seizure disorder. Epilepsia. 2006;47:323–329. doi: 10.1111/j.1528-1167.2006.00424.x. [DOI] [PubMed] [Google Scholar]
  • 10.Kupiec T, Raj V. Fatal seizures due to potential herb-drug interactions with Ginkgo biloba. J Anal Toxicol. 2005;29:755–758. doi: 10.1093/jat/29.7.755. [DOI] [PubMed] [Google Scholar]
  • 11.Bressler R. Herb-drug interactions between Ginkgo biloba and prescription medications. Geriatrics. 2005;60:30–33. [PubMed] [Google Scholar]
  • 12.Elferink JGR. Epilepsy and its treatment in the ancient cultures of America. Epilepsia. 1999;40:1041–1046. doi: 10.1111/j.1528-1157.1999.tb00815.x. [DOI] [PubMed] [Google Scholar]
  • 13.Kim IJ, Kang JK, Lee SA. Factors contributing to the use of complementary and alternative medicine by people with epilepsy. Epilepsy Behav. 2006;8:620–624. doi: 10.1016/j.yebeh.2006.01.020. [DOI] [PubMed] [Google Scholar]
  • 14.Lai CW, Huang X, Lai YHC, Zhang Z, Liu G, Yang MZ. A survey of public awareness, understanding and attitudes toward epilepsy in Henan province, China. Epilepsia. 1990;31:182–187. doi: 10.1111/j.1528-1167.1990.tb06304.x. [DOI] [PubMed] [Google Scholar]
  • 15.Danesi MA, Adetunji JB. Use of alternative medicine by patients with epilepsy: a survey of 265 epileptic patients in a developing country. Epilepsia. 1994;35:344–351. doi: 10.1111/j.1528-1157.1994.tb02442.x. [DOI] [PubMed] [Google Scholar]
  • 16.Vattanajun A, Watanabe H, Tantisira MH, Tantisira B. Isobolographically additive anticonvulsant activity between Centella asiatica’s ethyl acetate fraction and some antiepileptic drugs. J Med Assoc Thai. 2005;88(Suppl 3):S131–S140. [PubMed] [Google Scholar]
  • 17.Tandon M, Prabhakar S, Pandhi P. Pattern of use of complementary/alternative medicine (CAM) in epileptic patients in a tertiary care hospital in India. Pharmacoepidemiol Drug Saf. 2002;11:457–463. doi: 10.1002/pds.731. [DOI] [PubMed] [Google Scholar]
  • 18.Saper RB, Kales SN, Paquin J, et al. Heavy metal content of Ayurvedic herbal medicine products. JAMA. 2004;292:2868–2873. doi: 10.1001/jama.292.23.2868. [DOI] [PubMed] [Google Scholar]
  • 19.Huang WF, Wen KC, Hsiao ML. Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan. J Clin Pharmacol. 1997;37:344–350. doi: 10.1002/j.1552-4604.1997.tb04312.x. [DOI] [PubMed] [Google Scholar]
  • 20.Ernst E. Serious psychiatric and neurological adverse effects of herbal medicine: a systematic review. Acta Psychiatr Scand. 2003;108:83–91. doi: 10.1034/j.1600-0447.2003.00158.x. [DOI] [PubMed] [Google Scholar]
  • 21.Pearl PL, Robbins EL, Bennett HD, Conry JA. Use of complementary and alternative therapies in epilepsy: cause for concern. Arch Neurol. 2005;62:1472–1475. doi: 10.1001/archneur.62.9.1472. [DOI] [PubMed] [Google Scholar]
  • 22.Huxtable RJ. The harmful potential of herbal and other plant products. Drug Saf. 1990;5(Suppl 1):126–136. doi: 10.2165/00002018-199000051-00020. [DOI] [PubMed] [Google Scholar]
  • 23.Luciano DJ, Spinella M. Herbal treatment of epilepsy: phytotherapy. In: Devinsky O, Schachter SC, Pacia S, editors. Complementary and alternative therapies for epilepsy. New York: Demos Medical Publishing; 2005. pp. 143–155. [Google Scholar]
  • 24.Gil Campos M, Pérez Navero JL, Ibarra De La Rosa I. Convulsive status secondary to star anise poisoning in a neonate [In Spanish] An Esp Pediatr. 2002;57:366–368. [PubMed] [Google Scholar]
  • 25.Johanns ES, van der Kolk LE, van Gemert HM, Sijben AE, Peters PW, de Vries I. An epidemic of epileptic seizures after consumption of herbal tea [In Dutch] Ned Tijdschr Geneeskd. 2002;146:813–816. [PubMed] [Google Scholar]
  • 26.Miwa H, Iijima M, Tanaka S, Mizuno Y. Generalized convulsions after consuming a large amount of gingko nuts. Epilepsia. 2001;42:280–281. [PubMed] [Google Scholar]
  • 27.Spinella M. Herbal medicines and epilepsy: the potential for benefit and adverse effects. Epilepsy Behav. 2001;2:524–532. doi: 10.1006/ebeh.2001.0281. [DOI] [PubMed] [Google Scholar]
  • 28.Sirven JI. Alternative therapies for seizures: promises and dangers. Semin Neurol. 2007;27:325–330. doi: 10.1055/s-2007-985334. [DOI] [PubMed] [Google Scholar]
  • 29.Neto MM, Cardeal da Costa JA, Garcia-Cairasco N, Netto JC. Nakagawa B, Dantas M. Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome. Nephrol Dial Transplant. 2003;18:120–125. doi: 10.1093/ndt/18.1.120. [DOI] [PubMed] [Google Scholar]
  • 30.Carolino RO, Beleboni RO, Pizzo AB, et al. Convulsant activity and neurochemical alterations induced by a fraction obtained from fruit Averrhoa carambola (Oxalidaceae: Geraniales) Neurochem Int. 2005;46:523–531. doi: 10.1016/j.neuint.2005.02.002. [DOI] [PubMed] [Google Scholar]
  • 31.Oyungu E, Kioy PG, Patel NB. Proconvulsant effect of khat (Catha edulis) in Sprague dawley rats. J Ethnopharmacol. 2009;121:476–478. doi: 10.1016/j.jep.2008.10.037. [DOI] [PubMed] [Google Scholar]
  • 32.Wang Y, Zhou D, Wang B, et al. A kindling model of pharmacoresistant temporal lobe epilepsy in Sprague-Dawley rats induced by Coriaria lactone and its possible mechanism. Epilepsia. 2003;44:475–488. doi: 10.1046/j.1528-1157.2003.32502.x. [DOI] [PubMed] [Google Scholar]
  • 33.Obach RS. Inhibition of human cytochrome P450 enzymes by constituents of St. John’s wort, an herbal preparation used in the treatment of depression. J Pharmacol Exp Ther. 2000;294:88–95. [PubMed] [Google Scholar]
  • 34.Delgoda R, Westlake AC. Herbal interactions involving cytochrome P450 enzymes: a mini review. Toxicol Rev. 2004;23:239–249. doi: 10.2165/00139709-200423040-00004. [DOI] [PubMed] [Google Scholar]
  • 35.Jain S. Ayurveda: the ancient Indian system of medicine. In: Devinsky O, Schachter SC, Pacia S, editors. Complementary and alternative therapies for epilepsy. New York: Demos Medical Publishing; 2005. pp. 123–128. [Google Scholar]
  • 36.Ojewole JA. Anticonvulsant property of Sutherlandia frutescens R. BR. (variety Incana E. MEY.) [Fabaceae] shoot aqueous extract. Brain Res Bull. 2008;75:126–132. doi: 10.1016/j.brainresbull.2007.08.002. [DOI] [PubMed] [Google Scholar]
  • 37.Ojewole JA. Anticonvulsant activity of Hypoxis hemerocallidea Fisch. & C. A. Mey. (Hypoxidaceae) corm (‘African potato’) aqueous extract in mice. Phytother Res. 2008;22:91–96. doi: 10.1002/ptr.2272. [DOI] [PubMed] [Google Scholar]
  • 38.Mahomed IM, Ojewole JA. Anticonvulsant activity of Harpagophytum procumbens DC [Pedaliaceae] secondary root aqueous extract in mice. Brain Res Bull. 2006;69:57–62. doi: 10.1016/j.brainresbull.2005.10.010. [DOI] [PubMed] [Google Scholar]
  • 39.Chauhau AK, Dobhal MP, Joshi BC. A review of medicinal plants showing anticonvulsant activity. J Ethnopharmacol. 1988;22:11–23. doi: 10.1016/0378-8741(88)90226-7. [DOI] [PubMed] [Google Scholar]
  • 40.Kasture VS, Deshmukh VK, Chopde CT. Anxiolytic and anticonvulsive activity of Sesbania grandiflora leaves in experimental animals. Phytother Res. 2002;16:455–460. doi: 10.1002/ptr.971. [DOI] [PubMed] [Google Scholar]
  • 41.Kulkarni SK, Akula KK, Dhir A. Effect of Withania somnifera Dunal root extract against pentylenetetrazol seizure threshold in mice: possible involvement of GABAergic system. Indian J Exp Biol. 2008;46:465–469. [PubMed] [Google Scholar]
  • 42.Lai CW, Lai YH. History of epilepsy in Chinese traditional medicine. Epilepsia. 1991;32:299–302. doi: 10.1111/j.1528-1157.1991.tb04655.x. [DOI] [PubMed] [Google Scholar]
  • 43.Schachter SC, Acevedo C, Acevedo KA, et al. Complementary and alternative medical therapies. In: Engel J, Pedley TA, et al., editors. Epilepsy: a comprehensive textbook. 2nd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008. pp. 1407–1414. [Google Scholar]
  • 44.Kim HJ, Moon KD, Oh SY, Kim SP, Lee SR. Ether fraction of methanol extracts of Gastrodia elata, a traditional medicinal herb, protects against kainic acid-induced neuronal damage in the mouse hippocampus. Neurosci Lett. 2001;314:65–68. doi: 10.1016/S0304-3940(01)02296-0. [DOI] [PubMed] [Google Scholar]
  • 45.Hsieh CL, Tang NY, Chiang SY, Hsieh CT, Lin JG. Anticonvulsive and free radical scavenging actions of two herbs, Uncaria rhynchophylla (MIQ) Jack and Gastrodia elata Bl., in kainic acid-treated rats. Life Sci. 1999;65:2071–2082. doi: 10.1016/S0024-3205(99)00473-7. [DOI] [PubMed] [Google Scholar]
  • 46.Hsieh CL, Chang CH, Chiang SY, et al. Anticonvulsive and free radical scavenging activities of vanillyl alcohol in ferric chloride-induced epileptic seizures in Sprague-Dawley rats. Life Sci. 2000;67:1185–1195. doi: 10.1016/S0024-3205(00)00706-2. [DOI] [PubMed] [Google Scholar]
  • 47.Chiou LC, Ling JY, Chang CC. Chinese herb constituent β-eudesmol alleviated the electroshock seizures in mice and electrographic seizures in rat hippocampal slices. Neurosci Lett. 1997;231:171–174. doi: 10.1016/S0304-3940(97)00557-0. [DOI] [PubMed] [Google Scholar]
  • 48.Hsieh CL, Chen ME, Li TC, et al. Anticonvulsant effect of Uncaria rhynchophylla (Miq) Jack, in rats with kainic acid-induced epileptic seizure. Am J Chin Med. 1999;27:257–264. doi: 10.1142/S0192415X9900029X. [DOI] [PubMed] [Google Scholar]
  • 49.Minami E, Shibata H, Nunoura Y, Nomoto M, Fukuda T. Efficacy of shitei-to, a traditional Chinese medicine formulation, against convulsions in mice. Am J Chin Med. 1999;27:107–115. doi: 10.1142/S0192415X99000136. [DOI] [PubMed] [Google Scholar]
  • 50.Ameri A, Gleitz J, Peters T. Bicuculline-induced epileptiform activity in rat hippocampal slices: suppression by aconitum alkaloids. Planta Med. 1997;63:228–232. doi: 10.1055/s-2006-957659. [DOI] [PubMed] [Google Scholar]
  • 51.Sugaya E, Yuyama N, Kajiwara K, et al. Regulation of gene expression by herbal medicines: a new paradigm of gene therapy for multifocal abnormalities of genes. Res Commun Mol Pathol Pharmacol. 1999;106:171–180. [PubMed] [Google Scholar]
  • 52.Khan R, Krishnakumar A, Paulose CS. Decreased glutamate receptor binding and NMDA R1 gene expression in the hippocampus of pilocarpine induced epileptic rats: neuroprotective role of Bacopa monnieri extract. Epilepsy Behav. 2008;12:54–60. doi: 10.1016/j.yebeh.2007.09.021. [DOI] [PubMed] [Google Scholar]
  • 53.Park J, Wei H, Lawhon D, Schachter SC. Herbal formulas in epilepsy: a systematic review. Epilepsia. 2005;46(Suppl 8):215–215. [Google Scholar]
  • 54.Hijikata Y, Yasuhara A, Yoshida Y, Sento S. Traditional Chinese medicine treatment of epilepsy. J Altern Complement Med. 2006;12:673–677. doi: 10.1089/acm.2006.12.673. [DOI] [PubMed] [Google Scholar]
  • 55.Salih MA, Mustafa AA. A substance in broad beans (Vicia faba) is protective against experimentally induced convulsions in mice. Epilepsy Behav. 2008;12:25–29. doi: 10.1016/j.yebeh.2007.08.016. [DOI] [PubMed] [Google Scholar]
  • 56.Zhang YH, Zhao XY, Chen XQ, Wang Y, Yang HH, Hu GY. Spermidine antagonizes the inhibitory effect of huperzine A on [3H]dizocilpine (MK-801) binding in synaptic membrane of rat cerebral cortex. Neurosci Lett. 2002;319:107–110. doi: 10.1016/S0304-3940(01)02565-4. [DOI] [PubMed] [Google Scholar]
  • 57.Zangara A. The psychopharmacology of huperzine A: an alkaloid with cognitive enhancing and neuroprotective properties of interest in the treatment of Alzheimer’s disease. Pharmacol Biochem Behav. 2003;75:675–686. doi: 10.1016/S0091-3057(03)00111-4. [DOI] [PubMed] [Google Scholar]
  • 58.White HS, Schachter S, Lee D, Xiaoshen J, Eisenberg D. Anticonvulsant activity of huperzine A, an alkaloid extract of Chinese club moss (Huperzia serrata) Epilepsia. 2005;46(Suppl 8):220–220. [Google Scholar]
  • 59.Schachter SC, White HS, Murphree LJ, Stables J Huperzine A. In: Bialer M, Johannessen SI, Kupferberg HJ, Levy RH, Perucca E, Tomson T, editors. Progress report on new antiepileptic drugs: a summary of the Eighth Eilat Conference (EILAT VIII). Epilepsy Res 2007;73:10–11. [DOI] [PubMed]

Articles from Neurotherapeutics are provided here courtesy of Elsevier

RESOURCES