drug interaction in epilepsy management

#in india, ayurveidc medicines have been used for thousands of years, and adverse drug reactions are also fewer in frequency and severity. these facts lead to the concomitant use of both ayurvedic and modern medicines by the patient without the physicians knowledge.
* this can ultimately lead to drug interactions which could be useful or harmful for the patient
*in observed 2 patients, which had well controlled seizures who presented with sudden loss of seizure control: a detailed history taking ;revealed that they had started taking shankhapushpi, a purported memory ehancer- animal studies with rats were carried out with single and multiple doses of the two drugs given alone and in combination. it was seen that on chronic administration both the antiepileptic effect and plasma levels of phenytoin were reduced by shankhapushpi. single dose administration of the drugs did not lead to any change in phenytoin levels. but decreased its antiepileptic effect. the interaction was found to be pharmacokinetic and pharmacodynamic.
*another marketed memory enhancer, mentat has been shown to increase phenytoin levels in rabbits.
*honey a substance widely used as a good vehicle for a given ayurvedic medicine has show to decrease the bioavailability of carbamazepine.

#in one study the first ultra structural evidences of neuroprotective properties in semecarpus anacardium and withania somnifera has been reported.ashwagandha ( w. somnifera) is gamma - amniobutryic acid - a( (gaba-a) receptor agonist, and katuka ( p. kurroa) has antioxidant action equal to alpha - tocopherol, which has an effect on glutathione metabolism in the liver and brain. subacute toxicity studies of groups like w. sominifera did not reveal any toxicity.
* a methanolic extract of w. somnifera root contains an ingredient that has a gaba mimetic activity.
* a clinical trial of rejuvenating drugs for the nervous system ( medhya rasayana) on epilepsy suggested that these medicines reduce the frequency duration and severity of seizures and have not shown any side effects.
*brahmi rasayana an ayurvedic preparation was studied in mice and rats its effect on the cns at oral doses ranging between 1 and 30g/kg. the study suggests an involvement of the gaba-ergic system in the medication of cns effects of brahmi rasayana.
* piperine, an active alkaloid of the piper longum and piper nigum exerted a significant protection against tetbutyl hydroperoxide and carbon tetrachloride hepatotoxicity by reducing both in vitro and in vivo lipid peroxidation, reducing enzymes leakage of glutamate pyruvate transaminase ( gpt) and alkaline phosphate ( ap) and preventing the depletion of reduced gluththione (gsh) and total thiols in intoxicated mice. piperine and its derivatives are effective anticonvulsant drugs that antagonize convulsions induced by physical and chemical methods. they also have sedative tranquilizing and muscle relaxing effects

**treatment of chronic epilepsy includes brahmi juice with honey and shatavari with milk,it is shown that the blood histamine level decreased from 0.9 to 0.37 ug/ml by vamana and the same is emitted in vomitus. this indicated elimination of toxic materials ( suksha mala) from the cellular level.

***first restore the activities of the heart mind and channels ( strotras) occluded by the dosha by using samshodhan chikitsa. vataja should be treated with basti, pittaja with virechana and kafaga with vamana. this is followed by medicinal recipes. primary therapy described in epilepsy is snehana where narayan tail is commonly used followed by swedana,in epilepsy where drugs are suitably prepared, a common vehicle is honey and salt,nasya is also an important treatment:anu tail, panchendriya vardhan tail and fresh juice of nirgundi are commonly used formulations. shirodhara is another part of the treatment.this is basically the pacificatory therapy:medicated oil, ghrita, decoctions of various suitable herbs and buttermilk are used