ANTI EPILEPTICS AND MEDICINAL PLANTS

The central nervous system (CNS) is a nervous system that can control other nervous
systems in the body where it works under conscious awareness or will. The CNS is also known
as the central nervous system because it is the center or center of other nerves. The central
nervous system is divided into two, namely the brain (ensevalon) and the spinal cord (spinal
cord). Drugs that act on the central nervous system are divided into central nervous depressant
drugs, namely general anesthetics, sedative hypnotics, psychotropics, anticonvulsants,
analgesics, antipyretics, inflammations, stimulants of the central nervous system. Antiepileptics
are drugs that can treat epileptic seizures thanks to their anticonvulsant properties, namely to
relieve convulsions (severe clonus seizures).

Epilepsy is a disorder of brain function characterized by periodic and unpredictable

seizures. The cause is the simultaneous and sudden action of large groups of nerve cells in the
brain. Seizures are thought to originate in the cerebral cortex, and not from other central nervous
system structures such as the thalamus, brainstem, or cerebellum. Epileptic seizures are classified
into two, namely:

1. Partial seizure, which starts at the center of the cortex.

• Simple partials. Remaining consciousness, only showing abnormal activity of certain

parts of the body or muscle groups
• Complex partials. Disturbance of consciousness for 30 seconds to two minutes, often
accompanied by meaningless movements such as smacking the lips or squeezing the
hands, diarrhea, urination

2. Overall Seizure (Generalisata), involves a lot of both hemispheres from the start.

• Absence (Petit Mal). Disturbance of consciousness appears suddenly accompanied by

widened eyes and interruption of ongoing activities, usually lasting less than 30 seconds.
Exhibits rapid eye blinking that lasts up to 5 seconds.
• Tonic Clonic (Grand Mal). Loss of consciousness and continuous muscle contractions
(tonic) throughout the body followed by muscle contractions alternating with periods of
relaxation (clonic), usually lasting 1-2 minutes. Showing confused and tired eyes.
• Myoclonic Seizures. A brief (perhaps one second) shock-like muscle contraction that
may be limited to part of one limb or may be complete.

Drugs used:
A. Aminophylline

Aminophylline is used as a bronchodilator in the treatment of asthma and chronic

obstructive pulmonary disease. Aminophylline is also used to relieve obstructive babies.
Previously used as an adjunct in the treatment of heart failure, and may occasionally have a role
in patients with obstructive airway disease. To reduce side effects, intravenous aminophylline
should not be given at a rate greater than 25 mg/min. In adults who are not already taking
aminophylline, theophylline, or another xanthine-containing drug, an initial dose of 5 mg/kg
ideal body weight or 250 to 500 mg of aminophylline may be given intravenously over 20 to 30
minutes by slow injection or infusion, followed by another dose of infusion. maintenance 500
micrograms/kg per hour.

Caution: Aminophylline Injection may lower the seizure threshold and should be
administered with caution to patients with seizure disorders unless the patient is receiving
appropriate anticonvulsant therapy. Dosage adjustment of each anticonvulsant drug may be
necessary.

Adverse effects: The most common side effects encountered with theophylline and
xanthine derivatives regardless of route are gastrointestinal irritation and CNS stimulation.
Serum theophylline concentrations greater than 20 micrograms/mL (110 micromol/liter) are
associated with an increased risk of side effects. Overdose may also cause agitation, diuresis and
repeated vomiting (occasionally hematemesis) and consequent dehydration, cardiac arrhythmias
including tachycardia, hypotension, electrolyte disturbances including hypokalemia,
hyperglycemia, hypomagnesemia, metabolic acidosis, rhabdomyolysis, seizures, and death.

B. Diazepam

Diazepam is a drug in the benzodiazepine class. The most prominent effects of this class
of drugs are sedation, hypnosis, reduced anxiety, muscle relaxation, anterograde amnesia and
anticonvulsants. Benzodiazepines are believed to exert most of their effects through interactions
with inhibitory neurotransmitter receptors that are directly activated by GABA. Benzodiazepines
do not directly activate GABA receptors, but require GABA to activate their effects i.e. they only
modulate GABA effects.

Therapeutic Use: When given intravenously or rectally it is very effective in stopping

persistent seizure activity, especially in tonic-clonic status epilepticus. It is sometimes given
orally in chronic conditions, although it is not considered very effective for this application.

Side effects: The main side effects of diazepam are sedation, drowsiness, muscle
weakness and ataxia. This effect decreases with continued doses and is an effect of central
nervous system (CNS) depression. Other effects include headache, vertigo, slurred speech or
dysarthria, confusion, depression, tremors, changes in libido, urinary retention, gastrointestinal
disturbances, and amnesia. Some patients may experience paradoxical arousal such as anger,
aggression and embarrassment.

Epilepsy Medicinal Plants:

1. Gotu Kola leaves

Epilepsy is often treated traditionally with herbal ingredients, one of which is Gotu Kola
(Centella asiatica). Empirically, this plant, which is also known as Antanan, is known to reduce
the symptoms and frequency of epileptic seizures. Several active compounds such as
triterpenoids, brahmoside (Bacoside A), and brahminoside in this plant have sedative (soothing)
properties and are able to relax tense blood vessels. These medicinal plants have wound and
ulcer healing effects, antinociceptive and anti-inflammatory effects, protective effects against
psoriasis, cardioprotective, immunomodulatory, cytotoxic, anti-tumor, anxiolytic and antioxidant
properties. In a study by Manasa and Sachin, the anti-convulsant effect of gotu kola aqueous
extract was examined using the PTZ method. The anti-convulsant effect of Centella asiatica was
found to be comparable to the anti-convulsant effect of sodium valproate. The drug sodium
valproate is one of the drugs commonly prescribed to treat epilepsy.

The researchers found that the liquid extract of gotu kola at doses of 100 mg/kg and 300
mg/kg had the same anti-seizure effect in experimental subjects who had seizures induced via
PTZ. The anti-convulsant effect of gotu kola liquid extract at a dose of 300 mg/kg is comparable
to that of sodium valproate. Based on the results of this study it can be concluded that there are
benefits of gotu kola for epilepsy. In addition, many other studies have also reported the anti-
convulsant effect of Centella asiatica on various models of epilepsy. In a study by Gupta et al,
PTZ-induced cognitive impairment and oxidative stress were reduced by using gotu kola.
Research by Katare and Ganachari reported that Centella asiatica has anti-lipidperoxidative and
anti-epileptic effects on the lithium-pilocarpine model of epilepsy.
2. Papaya

Papaya is a type of fruit for people with epilepsy that is easily available. By consuming
only 140 grams of papaya fruit, you can meet about 13 percent of the daily requirement of folic
acid. The content of vitamin A and vitamin C in papaya is able to strengthen the immune system
and beta carotene compounds that are able to increase a person's immunity.

3. Garlic

Garlic is well known as a natural remedy for several health conditions, including
epilepsy. Garlic is an effective natural ingredient for treating epilepsy. How to use it, just boil
water, milk, and one crushed garlic clove. Consume the concoction once every day to reduce
seizures.

4. Saga leaves

One of the plants used empirically is the saga tree (Abrus precatorius L.) which is used
for the treatment of epilepsy, coughs and mouth sores. These leaves also contain the chemicals
flavonoids, abrin, choline, trigonelin, and others. These substances are claimed to have potential
antibacterial, anticancer, antioxidant, hepatoprotective (liver protective) and cardioprotective
(heart protective) effects.