{"id":67548,"date":"2025-09-30T10:26:10","date_gmt":"2025-09-30T10:26:10","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=67548"},"modified":"2025-10-03T19:20:07","modified_gmt":"2025-10-03T19:20:07","slug":"perceptions-and-experiences-of-indian-traditional-medicine-practitioners-in-managing-epilepsy-a-qualitative-study-in-malaysia","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol18no3\/perceptions-and-experiences-of-indian-traditional-medicine-practitioners-in-managing-epilepsy-a-qualitative-study-in-malaysia\/","title":{"rendered":"Perceptions and Experiences of Indian Traditional Medicine Practitioners in Managing Epilepsy: A Qualitative Study in Malaysia"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

Epilepsy, impacting approximately 70 million individuals globally, is a common neurological disorder that often leads to chronic disability, psychological distress, and social stigma.1<\/sup> Approximately thirty percent of patients experience drug-resistant epilepsy (DRE), characterised by persistent seizures despite adequate pharmacological intervention and the availability of many antiepileptic drugs (AEDs).2,3<\/sup> This therapeutic break down has prompted numerous individuals and families to seek alternative therapy choices, especially traditional medical systems with enduring cultural and clinical significance. It is estimated that globally, 7.5 \u2013 73.3% of individuals with epilepsy utilise\u00a0CAM\u00a0approaches, highlighting a significant patient demand that reflects the experiences reported in our study.14<\/sup><\/p>\n

Ayurveda, particularly Siddha, offers a distinctive and comprehensive approach to the treatment of epilepsy in South Asia.4-6<\/sup> Ayurvedic knowledge characterises epilepsy as Apasmara<\/em>\u2014a chronic, relapsing disorder associated with disturbances in memory, consciousness, and mental equilibrium, believed to arise from imbalances in the body’s elemental forces (doshas<\/em>) and mental states (gunas<\/em>).6-8<\/sup><\/p>\n

Standard therapy modalities include mind-body interventions (satvavajaya chikitsa<\/em>), lifestyle alterations, detoxification procedures (shodhana<\/em>), and the application of specific herbal treatments. Historically utilised for their neuroprotective and anticonvulsant properties, botanicals such as Brahmi (Bacopa monnieri), Jatamamsi (Nardostachys jatamansi), <\/em>and Ashwagandha (Withania somnifera)<\/em> are now corroborated by preclinical evidence.9,10 <\/sup>Diagnosis and treatment are frequently customised according to individual constitution (prakriti), pulse assessment, behavioural observation, and lifestyle factors.11<\/sup><\/p>\n

In addition to biological factors, Indian traditional medicine underscores the significance of the therapeutic connection, emotional support, and carer participation as essential components of recovery.12,13<\/sup> The relational dynamics are crucial to the CAM experience and frequently cited as factors contributing to patient satisfaction and long-term adherence.14,15 <\/sup>However, CAM is not an unified entity; variations in the types of practices utilised, simultaneous administration of AEDs, and the particular type of epilepsy may all affect patient reactions and overall efficacy.16,17<\/sup><\/p>\n

Although these systems are quite prevalent in India and among diaspora populations, there is a paucity of empirical research examining the clinical perspectives and personal experiences of traditional practitioners managing epilepsy. The majority of current study emphasise the role of traditional medicine practitioners in providing CAM, yet there is limited insight into traditional healers\u2019 perceptions of epilepsy, their therapeutic approaches, and their interactions with biomedical institutions. This study aims to address this gap by examining how practitioners of Indian traditional medicine understand and manage epilepsy. This research aims to elucidate clinical reasoning, therapeutic approaches, and perceived roles within the broader healthcare context through a qualitative examination of their perspectives.<\/p>\n

Materials and Methods<\/strong><\/p>\n

Study design and setting<\/strong><\/p>\n

This qualitative study adopted a thematic analysis orientation, implemented an exploratory approach utilizing in-depth face-to-face interviews to explore the perceptions and clinical experiences of Indian traditional medicine (Ayurveda) practitioners regarding the use of CAM in the treatment of epilepsy. Ethical permission was obtained from the Universiti Sultan Zainal Abidin, UniSZA Human Research Ethics Committee (UHREC) [Reference number: UniSZA\/UHREC\/2022\/439], and the study was also registered and approved by the National Medical Research Register (NMRR), Ministry of Health Malaysia [NMRR ID: 23-01207-PS8 (IIR)].<\/p>\n

Participants<\/strong><\/p>\n

A purposive sampling technique was employed to ensure participants had relevant expertise with CAM modalities in Ayurveda. Participants were recruited via a Google Form titled\u00a0\u2018Healthcare Providers\u2019 Opinion on CAM Use in Epilepsy Patients,\u2019<\/em>\u00a0which screened for eligibility and practice factors.\u00a0All practitioners who completed the form agreed to participate, and no refusals or dropouts occurred.\u00a0Maximum variation sampling was performed to include varied ethnic and practice backgrounds. Sampling continued until\u00a0data saturation was reached, defined as the point when no new codes or themes emerged during analysis.\u00a0All interviews were conducted between the researcher and the participant in a private setting, and\u00a0no other individuals were present during the sessions.<\/p>\n

Procedure and Interview Process<\/strong><\/p>\n

Face-to-face, in-depth interviews were conducted by three members of the research team, all with advanced academic qualifications in pharmacy and prior experience in qualitative research.\u00a0A semi-structured topic guide consisting of nine open-ended questions was used. These questions explored areas such as the perceived benefits and limitations of CAM, challenges in its use, practitioner\u2013patient communication, collaboration with other professionals, personalization of treatments, and approaches to diagnosis and treatment. The guide was developed based on prior literature and validated by five experts in the pharmacy field for relevance and clarity.18-20<\/sup> The questionnaire guide was prepared only in English, and no local language translation was produced.\u00a0To ensure methodological rigor, the interviewers\u2019 expertise in qualitative methods guided the sessions, with additional support from a trained research assistant.<\/p>\n

Participants were given an information sheet and provided written informed consent before the interview. A short ice-breaker was included to establish rapport. Interviews, conducted over three months, lasted 25 to 45 minutes, were held in private settings (clinics and workplaces), audio-recorded with participant permission, and supported by field notes. While English was the major language utilized, participants were permitted to respond in Bahasa Melayu or English, with real-time translation provided by the research assistant as appropriate. All interviews were recorded verbatim and anonymised for confidentiality.<\/p>\n

Data Analysis<\/strong><\/p>\n

This method encompassed several critical stages: data familiarization, open coding, categorization of codes into overarching themes, and the formulation of final themes and subthemes.21<\/sup>All coding and theme development were performed manually by the researcher using printed transcripts and structured coding sheets, in line with Braun & Clarke\u2019s six-phase framework for thematic analysis. The researcher did the coding, which was subsequently verified by a secondary researcher to strengthen the legitimacy and consistency of the findings. Disputes over coding or theme development were settled by dialogue and consensus. Field notes were utilized to enhance contextual comprehension and interpretation of the data. To ensure trustworthiness and rigor, the study followed to Guba and Lincoln\u2019s standards for qualitative research in generating credibility, transferability, dependability, and confirmability.22<\/sup> A flowchart detailing the study procedure is provided in Figure 1.\u00a0<\/strong><\/p>\n\n\n\n
\"\"<\/td>\nFigure 1: Study flowchart process<\/strong>Click here to view Figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Results <\/strong><\/p>\n

Eight Ayurveda practitioners participated in the study, achieving data saturation within this cohort. All interviews were conducted in person using a semi-structured guide. The participants included both male and female practitioners from Indian ethnic backgrounds, each with clinical experience ranging from 6 to 15 years in managing epilepsy with CAM. Table 1 summarizes participant demographics.<\/p>\n

Table 1: Demographics of the respondents<\/strong><\/p>\n\n\n\n\n\n\n\n
Characteristic<\/strong><\/td>\nDescription<\/strong><\/td>\n<\/tr>\n
Total number of respondents<\/td>\n8 (P1-P8)<\/td>\n<\/tr>\n
Experience (years)<\/td>\n5 \u2013 15<\/td>\n<\/tr>\n
GenderMale<\/em><\/p>\n

Female<\/em><\/td>\n

5
\n3<\/td>\n<\/tr>\n
Age (mean \u00b1 SD)Workplace<\/p>\n

Urban<\/em><\/td>\n

45.1\u202f\u00b1\u202f8.3 years8<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*P1-P8: Participant 1 \u2013 Participant 8<\/p>\n

Five main themes were identified, each with related sub-themes: (1) perceived value and limitations of CAM in epilepsy care, (2) therapeutic relationships and communication with patients, (3) individualized treatment and clinical decision-making, (4) integration with other healthcare systems, and (5) perceived impact on patients and families. These themes reflect the complex and holistic nature of Ayurvedic epilepsy care as practiced in the Malaysian context. Table 2 illustrates the themes.<\/p>\n

Table 2: Emerged themes from thematic analysis<\/strong>\u00a0<\/u><\/p>\n\n\n\n\n\n\n\n\n
No<\/strong><\/td>\nThemes<\/strong><\/td>\nSUB-THEMES<\/strong><\/td>\n<\/tr>\n
1<\/strong><\/td>\nPerceived Value and Limitations of CAM<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Holistic Benefits with Fewer Side Effects\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Limitations in Specific Epilepsy Types<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Systemic and Regulatory Constraints<\/td>\n<\/tr>\n

\u00a02<\/strong><\/td>\nTherapeutic relationships and Communication with Patient<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Trust-Building and Emotional Rapport\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Two-Way Communication and Continuous Feedback<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Social Reintegration and Emotional Support<\/td>\n<\/tr>\n

\u00a03<\/strong><\/td>\nIndividualized Treatment and Clinical Decision-Making<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Personalized Assessment and Dosage Adjustment\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Diagnostic Tools and Observational Skills<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Stepwise Therapeutic Philosophy<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Specific Herbal Formulations and Delivery Methods<\/td>\n<\/tr>\n

\u00a04<\/strong><\/td>\nIntegration with other Healthcare Systems<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Increasing Biomedical Referrals\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Peer Collaboration and Learning Platforms<\/td>\n<\/tr>\n
\u00a05<\/strong><\/td>\nPerceived Impact on Patients and Families<\/td>\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Clinical Improvements and Reduced Seizure Frequency\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Holistic Improvement and Quality of Life<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Empowerment and Adherence<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Theme 1: Perceived Value and Limitations of CAM in Epilepsy Care<\/strong><\/p>\n

Ayurveda practitioners emphasized that CAM treatments offered a holistic, gentle, and long-term approach for managing epilepsy. They believed CAM could calm neurological disturbances without the harsh side effects often associated with conventional antiepileptic drugs. However, they also recognized clear limitations when treating severe or structurally based epilepsy, and they described systemic barriers such as legal restrictions on herbal medicine use.<\/p>\n

Holistic Benefits with Fewer Side Effects<\/strong><\/p>\n

CAM was seen as non-invasive and restorative, particularly suitable for children or stress-related epilepsy cases. Calming therapies, dietary changes, and the use of medicated ghee were core strategies believed to stabilize the nervous system gently.<\/p>\n

\u201cSeizures… due to dysfunction of the brain cells… we calm them down. But calming is not only with medicine but it involves body detox, stress relief, and family support as well.\u201d \u2013 P7<\/em><\/p>\n

\u201cGhee plays a very very important role… it crosses the blood-brain barrier. That\u2019s why we process it with herbs so it acts like a carrier to deliver compounds to the brain and reduce seizure reactivity.\u201d \u2013 P6<\/em><\/p>\n

\u201cCAM gives a calming effect without the heaviness of allopathic side effects. The patient feels light, not drowsy. That\u2019s the difference we see.\u201d \u2013 P4<\/em><\/p>\n

Limitations in Specific Epilepsy Types<\/strong><\/p>\n

Participants acknowledged that not all epilepsy types respond equally to Ayurvedic therapies. In particular, conditions with congenital or degenerative origins were described as harder to treat or not curable with CAM alone.<\/p>\n

\u201cSome types of epilepsy like sannipata cannot be treated. These are very complex neurological, mental, and physical imbalances all together \u2026. sometimes the patient\u2019s structure is beyond healing.\u201d \u2013 P5<\/em><\/p>\n

\u201cThere are patients with long-standing seizure history or genetic involvement, but Ayurveda can help, but we can\u2019t reverse the brain damage. They remain stable, but not fully seizure-free.\u201d \u2013 P7<\/em><\/p>\n

Systemic and Regulatory Constraints<\/strong><\/p>\n

Legal limits on Ayurvedic products and lack of access to essential herbs restricted their treatment scope. Moreover, the absence of a psychological framework within some CAM models was identified as a gap.<\/p>\n

\u201cNo holistic approach psychologically… that\u2019s the biggest backdrop. We only focus on medicine, but emotional and lifestyle factors are huge in epilepsy.\u201d \u2013 P2<\/em><\/p>\n

\u201cLimited access\u2026 because certain herbs not allowed. We can\u2019t do full treatment sometimes due to import laws or bans.\u201d \u2013 P3<\/em><\/p>\n

Theme 2: Therapeutic Relationship and Communication with Patients<\/strong><\/p>\n

Practitioners highlighted the deeply relational nature of their work. Building trust with patients and families was not only central to diagnosis and treatment, but seen as therapeutic in itself. Communication was described as ongoing, two-way, and emotionally engaged.<\/p>\n

Trust-Building and Emotional Rapport<\/em><\/strong><\/p>\n

Trust emerged as a fundamental cornerstone of the therapeutic interaction. Practitioners emphasised that emotional safety, empathy, and mutual understanding must be created prior to effective treatment. This trust was influenced by personal experiences, enhancing their awareness of patients’ needs. One practitioner shared her experience treating her own child with epilepsy, underscoring the personal commitment involved.<\/p>\n

\u201cMy son… has seizures since 8 months old… I try to keep him calm. I\u2019ve lived this as a mother and a practitioner. I know what calmness, confidence, and a peaceful home can do.\u201d \u2013 P7<\/em><\/p>\n

Two-Way Communication and Continuous Feedback<\/strong><\/p>\n

Therapeutic relationships were sustained through regular follow-up, text-based updates from caregivers, and open dialogue about treatment effects and lifestyle changes.<\/p>\n

\u201cCommunication will be two-way. We don\u2019t just give medicine and wait. Parents message us, and we keep seizure records, every episode is tracked and analysed month by month.\u201d \u2013 P2<\/em><\/p>\n

\u201cEven small changes like headache or stress, families inform us so we can adjust the treatment. It\u2019s a cycle of sharing, not just us prescribing to the patient.\u201d \u2013 P4<\/em><\/p>\n

\u201cWe need updates from the patient to change medicine. If the seizure happens, how, when, what triggered it \u2026 we record all that regularly.\u201d \u2013 P5<\/em><\/p>\n

Social Reintegration and Emotional Support<\/strong><\/p>\n

Beyond seizure control, practitioners aimed to restore confidence, independence, and social functioning in their patients.<\/p>\n

\u201cHelping patients build confidence to reintegrate into society… is as important as stopping seizures. Many patients come feeling excluded or ashamed.\u201d \u2013 P5<\/em><\/p>\n

\u201cThey start going back to school, making friends. With Ayurveda, it\u2019s not only seizure control but it\u2019s giving them a chance to feel normal again.\u201d \u2013 P6<\/em>\u00a0<\/strong><\/p>\n

Theme 3: Individualized Treatment and Clinical Decision-Making<\/strong><\/p>\n

Ayurvedic practice was highly personalized. Diagnosis and treatment were tailored based on patient-specific factors such as pulse, digestion, age, symptoms, and emotional state. Therapies included herbal preparations, oils, and detox regimens administered in a stage-wise manner.<\/p>\n

Personalized Assessment and Dosage Adjustment<\/strong><\/p>\n

Treatment protocols were described as unique to each patient, adapted according to age, severity, and digestive strength. Adjustments were made over time as patient needs evolved.<\/p>\n

\u201cNo two treatments are the same. Even for the same epilepsy type, the dosage, herbs, and method change depending on digestion, mental state, and patient cooperation.\u201d \u2013 P6<\/em><\/p>\n

\u201cTreatment changes depending on age and severity. For children we go gentler, for adults more stabilising. It\u2019s not copy-paste treatment.\u201d \u2013 P8<\/em><\/p>\n

\u201cSome patients need more support for mental symptoms, others for physical heat. The combination is made specific to them.\u201d \u2013 P5<\/em><\/p>\n

Diagnostic Tools and Observational Skills<\/strong><\/p>\n

Practitioners relied on traditional diagnostic techniques such as pulse reading, as well as non-verbal cues including body language and energy levels.<\/p>\n

\u201cWe make decisions based on pulse diagnosis, symptoms, and epilepsy type. But also on how they speak, how they walk \u2026. it\u2019s all part of the diagnosis.\u201d \u2013 P5<\/em><\/p>\n

\u201cDiagnosis starts from how the person walks into the room. The posture tells you a lot, even their speech rhythm and tone give signals.\u201d \u2013 P6<\/em>\u00a0<\/em><\/strong><\/p>\n

Stepwise Therapeutic Philosophy<\/strong><\/p>\n

Treatment often began with detoxification, followed by calming therapies and then strengthening remedies. This approach was said to align with the body\u2019s natural rhythms.<\/p>\n

\u201cSometimes just detox makes a huge difference. Once the body is cleaned, the calming herbs work better. This order matters.\u201d \u2013 P4<\/em><\/p>\n

\u201cIt\u2019s like peeling layers where first remove the toxins, then rebuild the strength. That\u2019s why the patient must commit to the full process.\u201d \u2013 P6<\/em><\/p>\n

Specific Herbal Formulations and Delivery Methods<\/strong><\/p>\n

Practitioners used herbs like Brahmi<\/em>, Jatamamsi<\/em>, Manjishta<\/em>, and Shankhpushpi<\/em>, often administered in ghee, capsule, or decoction form. These were selected for their brain-calming and circulatory properties.<\/p>\n

\u201cHerbs like Brahmi, Jatamamsi, Kapikacchu… cross the blood-brain barrier. That\u2019s why we use ghee or oil to prepare the formula which it helps delivery to the nervous system.\u201d \u2013 P5<\/em><\/p>\n

\u201cManjishta and Shankhpushpi used in tablet form \u2026. also oil-based decoctions for absorption through skin or nasal route.\u201d \u2013 P7<\/em><\/p>\n

Theme 4: Integration and Collaboration with Other Health Systems<\/strong><\/p>\n

Participants described a gradual shift toward more collaborative care, particularly as some modern doctors began recognizing the value of CAM therapies. Peer learning and CME events also supported shared knowledge.<\/p>\n

Increasing Biomedical Referrals<\/strong><\/p>\n

Some reported that allopathic doctors referred patients for complementary care, particularly for patients dissatisfied with drug-based regimens.<\/p>\n

\u201cModern doctors are referring patients now. Especially those who don\u2019t respond to AEDs or those who want to avoid side effects.\u201d \u2013 P1<\/em><\/p>\n

\u201cSometimes neurologists send their parents or children to us when they want a drugless alternative. That\u2019s new but growing.\u201d \u2013 P3<\/em><\/p>\n

Peer Collaboration and Learning Platforms<\/strong><\/p>\n

Traditional practitioners reported a strong sense of collegiality with other Ayurveda providers, especially through continuing medical education (CME) events in India.<\/p>\n

\u201cInteraction mainly via CME in India. We attend conferences and share with other traditional practitioners.\u201d \u2013 P5<\/em><\/p>\n

\u201cWe align with traditional practitioners using oil-based treatments. It\u2019s a shared heritage, but we learn from each other too.\u201d \u2013 P6<\/em><\/p>\n

Theme 5: Impact of CAM Treatment on Patients <\/strong>and Families<\/span><\/strong><\/p>\n

Participants shared several success stories and noted improvements across physical, emotional, and social domains. Children especially showed promising outcomes with lifestyle changes and consistent Ayurvedic care.<\/p>\n

Clinical Improvements and Reduced Seizure Frequency<\/strong><\/p>\n

Many practitioners reported lower seizure frequency and increased seizure-free periods in their patients following treatment.<\/p>\n

\u201cChild… from monthly seizures to once a year. That\u2019s not magic but it\u2019s from strict diet, calm living, and consistency.\u201d \u2013 P1<\/em><\/p>\n

\u201cAdults… episode frequency reduced. But it takes patience. People want instant cure, we give progressive healing.\u201d \u2013 P2<\/em><\/p>\n

\u201cWe\u2019ve seen even drug-resistant cases come under control after long-term Ayurveda with commitment.\u201d \u2013 P4<\/em><\/p>\n

Holistic Improvement and Quality of Life<\/em><\/strong><\/p>\n

Patients were said to experience overall better emotional regulation, digestion, and mental clarity. Family members frequently noted these changes in their children, indicating favourable patient-centered outcomes.<\/p>\n

\u201c60 to 70% feel better overall holistically which help them have better digestion, better sleep, better mood.\u201d \u2013 P6<\/em><\/p>\n

\u201cSome patients showed up to 50% improvement. Some patients noted that not just seizures, but school, work, social life also improved.\u201d \u2013 P5<\/em><\/p>\n

\u201cParents tell us their children sleep better, talk more, and feel less anxious. That\u2019s success too.\u201d \u2013 P7<\/em><\/p>\n

Empowerment and Adherence<\/strong><\/p>\n

When patients trusted their practitioners and felt emotionally supported, their adherence improved and so did outcomes. CAM was seen as empowering patients to co-manage their care.<\/p>\n

\u201cThe best medicine… is the patient. We can only guide; they must walk the healing path.\u201d \u2013 P1<\/em><\/p>\n

\u201cDiet, behaviour, trust \u2026 all contributed. That\u2019s the triangle that keeps epilepsy stable in most patients we see.\u201d \u2013 P3<\/em><\/p>\n

\u201cWhen the family follows advice sincerely, the results show. That\u2019s why education and emotional support are part of treatment.\u201d \u2013 P4<\/em><\/p>\n

Discussion<\/strong><\/p>\n

This study provides an in-depth understanding of how Ayurvedic practitioners view and manage epilepsy. Their narratives reflect a holistic clinical perspective, perceiving epilepsy not solely as a neurological problem, but as a multifaceted affliction stemming from imbalances in physical, emotional, and spiritual realms. This perspective is fundamentally based on Ayurvedic knowledge, namely regarding epilepsy as Apasmara<\/em>, where disturbances in memory, consciousness, and the three doshas (vata, pitta, kapha)<\/em> are considered central to its pathophysiology.4,7-9<\/sup><\/p>\n

Participants in this study highlighted individualised evaluation and pulse-based diagnosis, aligning with Ayurveda’s constitutional methodology. These findings have been confirmed by clinical evaluations that illustrate how treatment is customised according to the patient’s lifestyle, psychosocial context, and constitutional type (prakriti).<\/em>9,11<\/sup> This context-specific care is facilitated by therapies that include purgatives, nasal administration, and oil-based external treatments such as shirodhara and abhyanga. These therapies, however historical, are currently being re-examined in integrative neuroscience for their influence on the autonomic nervous system.5,8,23<\/sup><\/p>\n

Additional, participants identified a therapeutic arsenal of many herbs that are well-documented in both traditional and contemporary pharmacology. Brahmi (Bacopa monnieri), Kapikacchu (Mucuna pruriens), Jatamamsi (Nardostachys jatamansi),<\/em> and Shankhpushpi (Convolvulus pluricaulis)<\/em> are often referenced for their contributions to soothing the nervous system, augmenting cognitive performance, and promoting neuroplasticity.() These herbs have exhibited anticonvulsant, antioxidant, and GABAergic modifying activities in preclinical and pharmacological investigations.9,10,24,25<\/sup> Similarly, preparations like Ashwagandharishta, Brahmi ghrita, and Saraswatarishta have been linked to decreased seizure frequency and mood stabilisation.4,5,8,26<\/sup><\/p>\n

Participants noted that ghee-based formulations were not just traditional but also provided a biological function by facilitating the transport of lipophilic substances across the blood-brain barrier, hence increasing brain delivery. This justification is progressively supported by pharmacological research affirming the role of ghee as a carrier in medication absorption and central nervous system targeting.4,5<\/sup> Additionally, network pharmacology research have revealed several drug-like phytochemicals in these plants that act synergistically on epilepsy-related targets.27<\/sup><\/p>\n

Regardless these proven advantages, participants recognised the constraints of CAM in addressing epilepsy with structural causes or irreversible neural impairment. This aligns with clinical data indicating that CAM therapies are more effective as complimentary interventions rather than as independent treatments for certain epilepsy subtypes.9,11<\/sup> Furthermore, regulatory obstacles including limited herb accessibility, absence of standardisation, and inadequate policy support were identified as impediments, corroborating conclusions from international CAM policy assessments.13,14<\/sup> Epidemiological data indicate that 20\u201340% of epilepsy patients remain DRE, with many actively seeking CAM\u00a0as supplemental methods, underscoring the clinical significance of these methods of treatment.28,29,30,31<\/sup><\/p>\n

A significant topic in the participants’ accounts was the therapeutic interaction. Practitioners perceived healing as profoundly relational, encompassing emotional support, trust cultivation, and sustained contact with patients and carers. This reflects the Ayurvedic concept of Satvavajaya chikitsa, which employs mental, behavioural, and spiritual therapies to achieve equilibrium.8,12<\/sup> These relational dynamics elucidate why numerous patients resort to complementary and alternative medicine after perceiving biological therapy as overly impersonal or inadequately responsive to psychosocial distress.13,15<\/sup><\/p>\n

Participants also reported enhanced inter-systemic collaboration. Some have observed that contemporary physicians are directing patients, particularly those with DRE or pursuing non-pharmacological alternatives. These experiences correspond with the integrative care models developing in India, where official and informal referrals between CAM and biomedical practitioners are increasingly prevalent.12,32<\/sup> Nonetheless, these connections are constrained by structural deficiencies in training, research translation, and regulatory integration.14<\/sup><\/p>\n

The results reported by practitioners decreased seizure frequency, enhanced emotional resilience, and improved quality of life are corroborated by recent studies on yoga, dietary changes, and Ayurvedic treatments.11,21,33<\/sup> Significantly, patients were characterised not as passive recipients but as active collaborators in their healing process. CAM practitioners underscored the importance of behavioural discipline, familial involvement, and compliance with daily routines as essential for sustained enhancement. This empowerment-oriented methodology is reflected in research about patient adherence and desire for CAM, especially in culturally rooted contexts such as India and Malaysia.14,15<\/sup><\/p>\n

Conclusion<\/strong><\/p>\n

This study offers insights into the clinical experiences and perspectives of practitioners of Indian traditional medicine (Ayurveda) in the management of epilepsy in Malaysia. The findings highlight the significance of CAM as a holistic, personalised, and culturally integrated approach to care. Practitioners highlighted the significance of emotional rapport, personalised diagnosis, and the therapeutic application of herbal and oil-based formulations in the management of seizure-related symptoms. In alongside reducing symptoms, the use of CAM was seen as beneficial in decreasing seizure frequency, enhancing emotional stability, and improving quality of life, highlighting its potential as a complementary approach in the management of epilepsy.<\/p>\n

Despite existing limitations, especially regarding the treatment of structurally based epilepsies and regulatory challenges, participants conveyed a sense of optimism regarding collaboration with biomedical professionals and a rising patient interest in integrative solutions. Meaningful outcomes were reported, including a reduction in seizure frequency, enhancement of emotional well-being, and an improved quality of life, especially in children.<\/p>\n

The findings underscore the necessity for inclusive health policies that acknowledge the significance of traditional systems such as Ayurveda. It is advisable to conduct additional research with larger and more diverse populations of practitioners and patients to investigate integration pathways, safety regulations, and long-term outcome monitoring.<\/p>\n

This study enhances the understanding of epilepsy management in traditional healing systems, providing implications for culturally competent, patient-centred care in pluralistic health systems.\u00a0<\/strong><\/p>\n

Acknowledgement <\/strong><\/p>\n

We would like to express our gratitude to the Director-General of Health Malaysia for granting permission to publish this article. We also appreciate all the peers who helped with the writing process of this manuscript, including Dr. Nurul Afiedia Roslim, Ms. Siti Maisarah Mohd Noor, and Ms. Nur Kamilah Mohd Fauzy.<\/p>\n

Funding Source<\/strong><\/p>\n

This project has been funded by the Ministry of Higher Education Malaysia under the Fundamental Research Grant Scheme (grant number: FRGS\/1\/2022\/SS0\/UNISZA\/01\/1).<\/p>\n

Conflict of Interest<\/strong><\/p>\n

The author(s) do not have any conflict of interest.<\/p>\n

Data Availability<\/strong><\/p>\n

This statement does not apply to this article<\/p>\n

Ethics Statement<\/strong><\/p>\n

Ethical approval was obtained from the UniSZA Human Research Ethics Committee (UHREC) (reference code: UniSZA\/UHREC\/20220439) and Medical Research and Ethics Committee (MREC), Ministry of Health (MoH) Malaysia (reference code: ID-23-01207-PS8 (IIR)).<\/p>\n

Informed Consent Statement<\/strong><\/p>\n

Written informed consent was obtained from all participants at the beginning of the study.<\/p>\n

Clinical Trial Registration<\/strong><\/p>\n

This research does not involve any clinical trials.<\/p>\n

Permission to reproduce material from other sources<\/strong><\/p>\n

Not applicable.<\/p>\n

Authors\u2019 Contribution<\/strong><\/p>\n