To report two cases of provoked seizures associated with Kratom and promote awareness of potential complications of this readily available herbal supplement.

Comorbidities frequently complicate the care of individuals with Epilepsy. Substance abuse is a common comorbidity. Kratom is a psychoactive plant comprised of compounds primarily targeting the mu and delta opioid receptors with adrenergic and serotonergic effects. Its effects are stimulating at low doses and sedating at high doses. It is being used as an alternative medicine to treat chronic pain and opioid withdrawal. Hence, it has recently become a popular recreational drug in the United States with an estimated three to five million users.

Case reports with literature review

A 24 year-old man had a first time generalized tonic-clonic (GTC) seizure following Kratom ingestion. No epilepsy risk factors were reported. Laboratory studies, neuroimaging, and electroencephalography were normal. Over the next two months, he had two more GTC seizures in the setting of Kratom ingestion. He has since ceased Kratom use with no seizures after 6 months.

A 33 year-old man with localization-related epilepsy secondary to a left temporal cavernoma presented with breakthrough seizures despite reported AED compliance. He reported antecedent Kratom ingestion. No additional provoking factors were identified. Laboratory studies were unremarkable and neuroimaging was unchanged.

We present two cases of men with seizures associated with Kratom use. Kratom has been linked to neurological complications (e.g. PRES) as well as systemic illness (e.g. hepatic toxicity). The FDA has raised concerns that Kratom has addictive properties. Attempts by the DEA to place the drug in a scheduling category have failed and it remains readily available. With widespread use, we believe it is necessary to promote awareness in the neurological community and make providers aware that it may cause seizures in a population shown to be susceptible to substance abuse.