Seizures associated with kratom (Mitragyna speciosa) use: A systematic review of published case reports
Year: 2025
Type: review
Study design: Systematic Review
Abstract: INTRODUCTION Kratom (Mitragyna speciosa) is increasingly used worldwide for its stimulant and opioidsubstitute properties.Reports of kratom-associated seizures have emerged, but the relationship remains poorly characterized.Our objective was to systematically review and synthesize published case reports and case series of seizures temporally associated with kratom use, in order to clarify clinical presentations, contributory factors, and outcomes.METHODS This was a systematic review conducted in accordance with PRISMA 2020 guidelines.PubMed, Europe PMC, and Scopus were searched through 2025 using the terms 'kratom', 'Mitragyna speciosa', 'seizure', 'epilepsy', and 'case report'.Human case reports and series describing seizures linked to kratom consumption were included.Data on patient demographics, kratom dosage and duration, coingestants, seizure type, diagnostic evaluations, management, and outcomes were extracted and analyzed descriptively.RESULTS Eleven publications (10 case reports and 1 case series) comprising 21 patients met inclusion criteria (20 adults, 1 maternal-neonatal case; male majority) The predominant seizure type was generalized tonic-clonic.Chronic high-dose kratom use (>1 year; up to >100 g/day) was common, and 71% of cases involved polysubstance co-ingestion (e.g.opioids, benzodiazepines, stimulants).EEG findings were variably abnormal or nonspecific; neuroimaging was largely unremarkable.Notably, kratom cessation was temporally associated with seizure resolution or marked improvement in at least eight cases.One neonatal seizure occurred within 24 hours of birth following in utero exposure.CONCLUSIONS Chronic, high-dose kratom use, especially when combined with other psychoactive substances, may precipitate seizures, most commonly generalized tonicclonic.Discontinuation of kratom appears to be a key component of effective management.Clinicians should routinely inquire about kratom and other herbal products when evaluating new-onset seizures.Prospective studies and standardized toxicology assessments are needed to define dose-related risks and underlying mechanisms.
Source: Public Health Toxicology
DOI: 10.18332/pht/209920
Author: Phisitphong Piyapanyamongkhon
Language: English
Subfield: Pharmacology
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W4414067491