Emilie Auditeau1, François Chassagne2, Geneviève Bourdy3, Mayoura Bounlu4, Jérémy Jost5, Jaime Luna6, Voa Ratsimbazafy7, Pierre-Marie Preux8, Farid Boumediene9. 1. INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France. Electronic address: emilie.auditeau@unilim.fr. 2. UMR 152 Research Institute for the development, University Toulouse 3, Pharmaceutical sciences Faculty, 35 chemin des Maraîchers, 31400 Toulouse, France; Center for the Study of Human Health, Emory University, Atlanta, GA, USA. Electronic address: francois.chassagne@ird.fr. 3. UMR 152 Research Institute for the development, University Toulouse 3, Pharmaceutical sciences Faculty, 35 chemin des Maraîchers, 31400 Toulouse, France. Electronic address: genevieve.bourdy@ird.fr. 4. INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Institute of Francophonie for Tropical Medicine, Vientiane, Lao Democratic People's Republic. Electronic address: mayura.boulu@etu.unilim.fr. 5. INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France. Electronic address: jeremy.jost@unilim.fr. 6. INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France. Electronic address: jaime.luna@etu.unilim.fr. 7. INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France. Electronic address: voa.ratsimbazafy@chu-limoges.fr. 8. INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France. Electronic address: pierre-marie.preux@unilim.fr. 9. INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France. Electronic address: farid.boumediene@unilim.fr.
Abstract
RELEVANCE: More than 70 million people suffer epilepsy worldwide. Low availability of anti-epileptic drugs, side-effects and drug-resistant epilepsy affect the quality of life of persons with epilepsy in countries with a poorly developed health system. Herbal medicine is frequently used for this neurological condition. OBJECTIVES: The main objective was to provide a detailed analysis of Herbal Medicine used for neurological conditions related with epilepsy in Asia, Africa and Latin America. More broadly, this study aims to highlight species with assessed efficacy (cross-cultural use, pharmacological effects on models of epileptic seizures) and safety (toxicological data in laboratory) information, in order to point out species of interest for further studies. A critical assessment of models used in pharmacological evaluations was done. MATERIALS AND METHODS: The systematic search for Herbal Medicine treatments for epilepsy was performed considering all the articles published until February 2017 through three scientific databases. It was made with MeSH terms and free text defining the epilepsy seizures and plant species. We included studies carried out in Asia, Africa and Latin America. All articles reporting the use of Herbal Medicine to treat epilepsy seizures and/or their pharmacological evaluation were retained for further analysis. RESULTS: The search yielded 1886 articles, from 30 countries. Hundred and six articles published between 1982 and 2017 were included, corresponding to a total of 497 use reports for 351 plant species belonging to 106 families. Three hundred and seventy seven use reports corresponding to 264 species in ethnopharmacological surveys and 120 evaluation reports corresponding to 107 species were noted. Twenty-nine reports, for 29 species, combined both ethnopharmacological and pharmacological evaluation. Fifty eight studies originated from Africa, 35 studies from Asia and 18 from Latin America. Highest use report was noted for rhizomes of Acorus calamus L. (12 use report in 1 country) and leaves of Bacopa monnieri (L.) Wettst. (8 use report in 2 countries). Therefore these species display the highest use convergence. Regarding pharmacological evaluation most studied species were: Leonotis leonurus (L.) R.Br. (4 evaluation reports in 1 country), Uncaria rhynchophylla (Miq.) Miq. ex Havil. (3 evaluation reports in 2 countries) and Calotropis gigantea (L.) Dryand. (3 evaluation reports in 1 country). In vivo models of chronic epilepsy were more relevant than in vitro models or chemical models inducing acute seizures for pharmacological assessment. CONCLUSION: Species with the highest use report were not those with pharmacological evaluation. It will be pertinent to assess the pharmacological effects and safety of medicinal plants used mostly by traditional healers on predictive models of seizures.
RELEVANCE: More than 70 million people suffer epilepsy worldwide. Low availability of anti-epileptic drugs, side-effects and drug-resistant epilepsy affect the quality of life of persons with epilepsy in countries with a poorly developed health system. Herbal medicine is frequently used for this neurological condition. OBJECTIVES: The main objective was to provide a detailed analysis of Herbal Medicine used for neurological conditions related with epilepsy in Asia, Africa and Latin America. More broadly, this study aims to highlight species with assessed efficacy (cross-cultural use, pharmacological effects on models of epileptic seizures) and safety (toxicological data in laboratory) information, in order to point out species of interest for further studies. A critical assessment of models used in pharmacological evaluations was done. MATERIALS AND METHODS: The systematic search for Herbal Medicine treatments for epilepsy was performed considering all the articles published until February 2017 through three scientific databases. It was made with MeSH terms and free text defining the epilepsy seizures and plant species. We included studies carried out in Asia, Africa and Latin America. All articles reporting the use of Herbal Medicine to treat epilepsy seizures and/or their pharmacological evaluation were retained for further analysis. RESULTS: The search yielded 1886 articles, from 30 countries. Hundred and six articles published between 1982 and 2017 were included, corresponding to a total of 497 use reports for 351 plant species belonging to 106 families. Three hundred and seventy seven use reports corresponding to 264 species in ethnopharmacological surveys and 120 evaluation reports corresponding to 107 species were noted. Twenty-nine reports, for 29 species, combined both ethnopharmacological and pharmacological evaluation. Fifty eight studies originated from Africa, 35 studies from Asia and 18 from Latin America. Highest use report was noted for rhizomes of Acorus calamus L. (12 use report in 1 country) and leaves of Bacopa monnieri (L.) Wettst. (8 use report in 2 countries). Therefore these species display the highest use convergence. Regarding pharmacological evaluation most studied species were: Leonotis leonurus (L.) R.Br. (4 evaluation reports in 1 country), Uncaria rhynchophylla (Miq.) Miq. ex Havil. (3 evaluation reports in 2 countries) and Calotropis gigantea (L.) Dryand. (3 evaluation reports in 1 country). In vivo models of chronic epilepsy were more relevant than in vitro models or chemical models inducing acute seizures for pharmacological assessment. CONCLUSION: Species with the highest use report were not those with pharmacological evaluation. It will be pertinent to assess the pharmacological effects and safety of medicinal plants used mostly by traditional healers on predictive models of seizures.