Reappraisal of Traditional Persian Medicine in the Treatment of Epilepsy and Seizure

Background:: Epilepsy is a prevalent and serious brain disorder. Although drug therapy is commonly used to treat epilepsy, a significant portion of patients experience drug-resistant seizures. Alternative treatments such as ketogenic diets, brain neurostimulators, and surgical resection are available but may not be suitable for all patients. Traditional Persian Medicine (TPM) manuscripts offer insights into various therapeutic approaches for epilepsy. Aim:: This study aims to compile and discuss the use of herbal therapies for epilepsy as outlined in ancient Persian manuscripts. Additionally, this study investigates the antiepileptic activities and mechanisms of actions of herbal remedies using contemporary medical literature Methods:: Two main search strategies were employed. Firstly, ancient Persian pharmaceutical manuscripts were analyzed to extract information about herbal remedies for epilepsy. These manuscripts included five primary texts that are highly regarded in TPM. Secondly, contemporary electronic databases such as Google Scholar, Scopus, PubMed, and ScienceDirect were searched to obtain information on the antiepileptic activities and mechanisms of action of the identified herbal remedies. Furthermore, the models/methods and extract types utilized in the studies were retrieved. Results:: The ancient Persian manuscripts revealed the identification of 102 medicinal plants used for the treatment of epilepsy, with the Apiaceae family being the most recommended. The most common route of administration was oral, but topical and nasal application methods were also mentioned. However, limited information regarding adverse effects was provided. Out of the 102 plants, 67 with scientifically approved names were included in the study. According to the recent literature review, many of these plants exhibited antiepileptic activities in animal studies, with their mechanisms of action primarily involving the GABAergic, opioid, and NMDA systems. Moreover, the MAO-A inhibitory properties of these plants, as a previously confirmed antiepileptic mechanism, were assessed. Conclusion:: The findings of this study highlight a wide range of medicinal plants used in TPM for epilepsy treatment. Several of these plants have demonstrated antiepileptic properties in animal studies, suggesting their potential effectiveness. Further research is needed to evaluate the efficacy and safety of these herbal remedies in human participants. The outcomes of such research may potentially lead to the development of new antiepileptic treatments with reduced side effects.