Herbal Medicines and Epilepsy: The Potential for Benefit and Adverse Effects

Status Epilepticus Associated with Borage Oil Ingestion

“…Numerous herbal medicines have effects in the central nervous system and have the potential for adversely affecting patients with epilepsy [1]. New-onset seizures have been reported to occur in patients taking CAM when no other cause has been found [2].…”

“…Complementary and alternative medicine (CAM) use has increased significantly in the past few decades [1,2].…”

“…There are a number of herbs that potentially contain neurotoxic compounds [1]. Borage seed oil is derived from the seeds of the borage plant (Borago officinalis).…”

Botanicals and Herbs: A Traditional Approach to Treating Epilepsy

“…21,22 Numerous herbal therapies have been anecdotally reported to cause seizures, including in patients with epilepsy 23 ; these include anisatin (a component of Japanese star anise, or Ilicium anisatum), which is used in Spain and other countries to treat infant colic, 24,25 ginkgo nuts, 26 essential oils, 27 evening primrose (Oenothera species) and borage (Borago officinalis), 27 and the stimulant ephedra (ma huang, or Ephedra sinica). 28 The extract of star fruit (Averrhoa carambola) may cause seizures in uremic patients 29 ; it is used to induce seizures experimentally, 30 as is the extract from Catha edulis (khat), whose fresh young leaves are used recreationally by an estimated 5 million people in eastern Africa and the Arabian Peninsula.…”

“…32 The pharmacokinetic interactions between herbal therapies and drugs, including AEDs, have been inadequately studied. Available evidence suggests that St. John's wort, 33 garlic, echinacea (various Echinacea species), pine bark extract (Pinus pinaster; also known as pycnogel, Pygenol, or Pycnogenol), milk thistle (Silybum species), American hellebore (Veratrum viride), ginkgo, 10,11 mugwort (Artemisia species), and pipsissewa (Chimaphila umbellata) affect the cytochrome P450 system and could therefore potentially affect serum concentrations of hepatically metabolized AEDs, [21][22][23][24][25][26][27][28][29][30][31][32][33][34] perhaps with fatal consequences. 10 …”