Botanicals for epilepsy

A large number of people with epilepsy (PWE) all over the world use botanicals as supplements or replacements of synthetic antiepileptic drugs (AEDs) or because herbal medicines are the only available or acceptable form of therapy. Traditional healers and some medical practitioners prescribe botanicals, but often, patients taking plant medicines don't tell their doctors about it. Basic researchers have studied anticonvulsant effects of botanicals formore thanhalf a century, but clinical research is virtually lacking. This special issue of Epilepsy & Behavior is dedicated to botanicals, or plant medicines, as a therapeutic option for treating epileptic seizures,which has attractedpublic attention through the recent interest in the possible therapeutic use of Cannabis for epilepsy. In this special issue, we bring together reviews of traditional use, basic research, and clinical experience with botanicals for epilepsy. The use of botanicals originates in traditional medical systems and indigenous societies. Traditional Chinese Medicine (TCM) and Ayurveda are two examples of age old traditional medical systems that not only have extensive therapeutic experience in the use of botanicals but also possess extensive and complete theoretical systems underpinning clinical practice, which are often difficult to grasp forWestern-trained physicians and scientists. Dr. Xiao et al. [1] review the use of botanicals for epilepsy in TCM. Dr. Sriranjini et al. [2] describe the use of botanicals for epilepsy in the holistic medical system of Ayurveda. It is estimated that 90% of people with epilepsy live in developing countries, and most of them receive no drug treatment for the disease. Dr. Kakooza-Mwesige [3] introduces the issues around the fascinating and challenging topic of the role botanicals play for the treatment of epilepsy in traditional societies in developing countries where access to conventional medical care and pharmaceuticals is limited. But even where access to anticonvulsant drugs is not a problem, seizures in up to 30% of PWE do not respond to treatment, andmany AEDs exhibit serious adverse effects. This treatment gap hasmotivated investigations by researchers all over the world into the effects of plants that have been used by traditional healers to treat seizures. Extracts of hundreds of plants have been shown to exhibit anticonvulsant activity in phenotypic screens performed in experimental animals. Dozens of plant-derived chemical compounds have similarly been shown to act as anticonvulsants in various in vivo and in vitro assays. In their review, Drs. Sucher and Carles [4] show that the described anticonvulsant effects of plant extracts can be attributed to specific secondary metabolites and their interactions with molecular targets in the brain, particularly ligand-gated and voltage-gated ion channels. Together, the data provide a pharmacological basis of the anticonvulsant effects and, thus, justification for clinical studieswith selected standardized botanical extracts and plant-derived compounds.