Treatment of Epilepsy in Ayurveda

Various Ayurvedic treatment modalities that include strong elimination and alleviation therapies, depending upon specific requirements, are useful for epilepsy patients. When epilepsy is associated with extrinsic factors, then mantras (hymns) have been recommended. The physician is advised to first take steps to awaken the heart channels and unblock the mind blocked by the dosas through drastic emesis (Vatika Apasmara), enema (Paittika Apasmara), and purgatives (Slaismika Apasmara). Drug formulations are recommended only after the patient has been cleansed by all means and consoled

Commentary

Similar to traditional Chinese herbal medicine (TCHM), Ayurvedic medicine has been practiced for millennia. The practice includes not only medicinal and dietary treatments but also commonsense behavioral prescriptions such as, "Patients with epilepsy should avoid being in places where a seizure could result in injury" (1). As with TCHM, many of the compounds used are likely to be pharmacologically active agents. Fortunately, as highlighted in a review by Khan and Balick of the New York Botanical Gardens (2), the effects of many plant species used in Ayurvedic medicine have been preliminarily studied in both humans and animals. Studies now reveal the beneficial effects of several herbal remedies for ailments, including burns (3), diabetes (4), asthma, and pain (5). A study examined the antiepileptic and antianxiety effects of the common Ayurvedic epilepsy herbal medicine Sesbania grandiflora (6). The plant demonstrated clear antiseizure effects when evaluated using the same standard laboratory measures that assess the potential efficacy of antiepileptic medications approved in the U.S. by the FDA. Pharmacological potency will undoubtedly be found for other Ayurvedic therapies, once properly investigated.

Despite the mounting evidence that many Ayurvedic medicines do have potential benefits, most herbal treatments have never been rigorously studied, in trials like those required for the FDA approval of antiepileptic medications. Equally important, even less is known about the potential side effects and interactions of these herbs with other medications. It is impossible to advocate for the use of diets and dietary supplements without the same degree of careful testing. This applies even more strongly to invasive procedures, such as bloodletting, that have no scientific basis for the treatment of epilepsy.

The issue of safety is extremely important with regard to Ayurvedic herbs and medicines (7). Lead poisoning and other heavy metal toxicity can occur with the use of some Ayurvedic therapies (e.g., herbal tonics) (8,9). Also, although the author advocates strong cleansing regimens to purify the body, the editors only recommend the consideration of Ayurvedic medications after consultation with a neurologist: Cleansing with emetics or purgatives can reduce antiepileptic drug levels and cause more frequent, severe, or prolonged seizures. Their use should only be undertaken with the knowledge of the doctor prescribing antiepileptic drugs. We strongly recommend against initial treatment with Ayurvedic medications (as opposed to standard antiepileptic drugs, which have proven efficacy).

We agree with Dr. Jain that thousands of years of practical experience should not be summarily dismissed, but rather mined for its great potential. This will only occur when the most promising of these treatments are studied in an unbiased, critical manner.

References

1. Manyam BV. Epilepsy in ancient India. Epilepsia 1992;33(3):473-475.

2. Khan S, Balick, MJ. Therapeutic plants of Ayurveda: a review of selected clinical and other studies for 166 species. J Altern Complement Med 2001;7(5):389-392.

3. Priya KS, Gnanamani A, Radhakrishnan N, et al. Healing potential of Datura alba on burn wounds in albino rats. J Ethnopharmacol 2002;83(3):193-199.

4. Grover JK, Yadav S, Vats V. Medicinal plants of India with anti-diabetic potential. J Ethnopharmacol 2002;81(1):81-100.

5. Singh RK, Achrarya SB, Bhattacharya SK. Pharmacological activity of Elaeocarups sphaericus. Phytother Res 2000;14(1):36-39.

6. Kasture VS, Deshmukh VK, Chopde CT. Anxiolytic and anticonvulsive activity of Sesbania grandiflora leaves in experimental animals. Phytother Res 2002;16(5): 455-460.

7. Gogtay NJ, Bhatt HA, Dalvi SS, Kshirsagar NA. The use and safety of non-allopathic Indian medicines. Drug Saf 2002;25(14):1005-1019.

8. Dunbabin DW, Tallis GA, Popplewell PY, Lee RA. Lead poisoning from Indian herbal medicine (Ayurveda). Med J Aust 1992;157(11-12):835-836.

9. Parab S, Kulkarni R, Thatte U. Heavy metals in "herbal" medicines. Indian J Gastroenterol 2003;22(3):111-112.

well. (Note: The editors only recommend consideration of Ayurvedic medications after consultation with a neurologist; cleansing with emetics or purgatives can reduce antiepileptic drug levels and cause more frequent, severe, or prolonged seizures.)

A wide variety of ghrtas (purified butters) are recommended for internal use. One of the most important is Maha Panca Gavya Ghrta. Using mixtures of ghrta and taila (oil) cooked with drugs is also mentioned. Oils cooked with different herbal and ani-

mal products are recommended for anointing the body of the patient. Nasyas (nasal applications) are also used. The use of a wide variety of anjanas (collyriums) and anjana vartikas (collyriu sticks) to bring the patient to his senses is mentioned. Some unusual prescriptions are also used, such as bile of dog collected in Pusya constellation as collyrium and also as fumigant after mixing with ghrta. Another such prescription consists of a fermented liquor prepared from the half-digested contents of a pig's stomach, the pig having been previously fed with a specially prepared diet of boiled rice and the milky juice of the bhargi plant (Clerodendron siphonanthus) after a prolonged period of fasting. The contents of the pig's stomach are taken out surgically, dried, and powdered. The powder is suspended in an aqueous decoction of the bhargi plant. Adding sediments of wine induces fermentation, and the resulting alcoholic product is matured until it acquires a specific color and consistency. Fumigation of different types also is recommended (2,4).

The modes of drug administration for epilepsy in Ayurveda include external applications, internal use, and application in the eyes and nose. The only first-aid measure recommended in epilepsy is blood-letting (Siravedha) from the veins of the temples. Cauterization of both the parietal bones with needles (Soocivedha) has also been mentioned (2,4).

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