Herbal products have been taken for centuries for a variety of reasons. Over the past 15 years, more and more people have taken herbal products for their general health.

Popular herbal products in America include: gingko biloba, echinacea, garlic, ginseng, soy, saw palmetto, St. John’s wort, valerian and cranberry. Likewise, studies show that people with chronic medical conditions increasingly take herbal products, too. Nearly 1-in-3 people with epilepsy use some form of complementary and alternative medicine. The most common herbs include: ginseng, St. John’s wort, melatonin, gingko biloba, garlic and black cohosh.

But are herbs safe for people with epilepsy? Do they work? After all, if most prescription drugs originally come from plants, herbal products must be good for a person’s health, right?

Well, here’s the bottom line: at this time, research studies of people with epilepsy have not conclusively shown that any herbal product effectively and safely treats seizures or other medical conditions commonly experienced by people with epilepsy, such as migraine headaches, depression, anxiety, memory loss and fatigue. And here’s the punch line: despite being “natural,” some herbs have the potential for making seizures worse and weakening the effects of seizure medicines. This article is meant to answer frequently asked questions so people can better evaluate whether to take herbal products.

Are herbs regulated like prescription drugs?

No, they’re not. Herbal products are classified by the government as dietary supplements, not prescription drugs. By law, dietary supplements are regulated by the 1994 Dietary Supplement and Health Education Act (DSHEA), whereas prescription drugs must meet the more rigorous requirements of the Federal Food, Drug and Cosmetic Act.

Under the DSHEA, manufacturers of herbal products are responsible for the truthfulness of the claims they make on their products’ labels. They are also responsible for controlling the quality of their products and verifying that they are safe.

However, no government agency, including the Food and Drug Administration, independently reviews and verifies the claims, supporting evidence, quality and safety of herbal products. Manufacturers may claim their herbal product has some effect on a part of the body or its function, but they cannot claim it is effective against a specific disease or medical condition, such as epilepsy. They must state on the label the FDA has not evaluated their product.

Does the FDA check how herbal products are manufactured?

Again, no. The manufacturing of prescription drugs is supervised by the FDA and guided by a set of guidelines called Good Manufacturing Process. No government agency, including the FDA, independently verifies the production of herbal products. In addition, manufacturers of herbal products do not have to follow Good Manufacturing Process standards. Therefore, herbal products could potentially be contaminated with microorganisms, pesticides or toxic metals, and adulterated with other herbs or drugs. Also, the potency and amount per pill may vary significantly within the same bottle, from batch-to-batch, or from one branded product to another because of variable manufacturing processes.

Are the active ingredients of herbal products known?

Generally not, and this is a major limitation to taking herbal products. For example, it is generally assumed that the active ingredient in St. John's wort is hypericin, and St. John’s wort products are generally made to be 0.3 percent hypericin. However, hypericin has never been confirmed as the active ingredient of St. John’s wort.

If you don’t know the active ingredient of an herbal product, the quality control of that herbal product is not independently verified. Therefore, you can’t measure the active ingredient in the blood stream and you can’t be certain of how much of the herbal product to take. These are big problems.

Can herbal products interfere with seizure medicines?

Yes, that is certainly possible, and not enough research has been done in this area. We do know, for example, that taking St. John’s wort for more than a couple weeks can lower the blood level of a person taking carbamazepine. Long-term use of St. John’s wort can also potentially lower the effectiveness of birth control pills. These are only a couple reasons why it’s very important to tell your doctor if you are taking any herbal products or dietary supplements.

Are any herbal products proven safe and effective for persons with epilepsy?

Research studies of people with epilepsy have not conclusively shown that any herbal product effectively and safely treats seizures or other medical conditions commonly experienced by people with epilepsy. Clinical trials of herbal products are not generally monitored by the FDA, and the results of these trials are often difficult to interpret because of the quality control issues discussed earlier. Some herbs and aromatic oils have actually been reported to provoke seizures.

Remember, just because something is natural doesn’t mean it’s safe. Take, for example, poison ivy.

Is there any good news about herbal products for epilepsy?

Yes! Epilepsy researchers increasingly recognize herbal products have a centuries-old tradition of being used to treat the condition in many countries. So, scientists are beginning to study herbal products more carefully, trying to identify the active ingredients that could then be further tested under the FDA’s supervision as possible new treatments for epilepsy. And this year, for the first time, herbal products will be discussed at the American Epilepsy Society’s annual meeting in Washington, D.C.

Steven Schachter, M.D., is a professor of neurology at Harvard Medical School, and a member of the Epilepsy Foundation’s professional advisory board.

Reprinted with permission from the Epilepsy Foundation.

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