Therapeutic potential of herbal drugs in cerebral ischemia

Stroke is one of the most important causes of mortality and morbidity in the world. Prevention and effective treatment of stroke is of the utmost importance. Cerebral ischemia causes disturbances in a variety of cellular and molecular mechanisms, including oxidative phosphorylation, membrane function, neurotransmitter release, and free radical generation. It has been years since tissue-type plasminogen activator (t-PA) became the first medication approved by the FDA for the management of stroke, with limited success. Thrombolytic therapy is the most effective therapeutic strategy for the prevention of brain injury and reduction of mortality in patients with cerebral infarction. However, a combination of established thrombolytic therapy and effective neuronal protection therapy may have more beneficial effects for patients with cerebral infarction. Because clinical trials of pharmacological neuroprotective strategies in stroke have been disappointing, attention has turned towards approaches which include herbal drugs that can be used in limiting the neurological damage associated with stroke. Herbal drugs may be used as prophylactic treatment in patients with high risk of stroke. Herbals drugs have been described in ancient systems of medicine for the treatment of various ailments associated with stroke and have more recently been reported to be beneficial in treating stroke. However, the strength of evidence to support the use of these herbal drugs is unclear. This review focuses on putative mechanisms underlying the beneficial effects of herbal drugs in patients with stroke and on the possibility of herbal drugs to increase the therapeutic time window in patients with cerebral ischemia.