To determine the incidence of Kratom-induced seizures to help propose methods for better evaluation of these patients.

Kratom (Mitragyna speciosa) is a widely-legalized substance that has both stimulant- and opioid-like effects. Reasons for Kratom use ranges from pain relief to euphoria. Although the American Kratom Association claims that use is benign, there have been many reported adverse effects. One insidious effect is seizures. To date, there have only been a few case reports on Kratom-induced seizures.  

A literature search was conducted in both PubMed and Scopus to find Kratom-induced seizure case reports/series. The search string consisted of a derivative of “Kratom” and “adverse effect” and “seizure.” General Kratom review articles were read for any other potential references not included in the search. A total of 77 articles were retrieved, and 11 articles with 23 unique patients were analyzed.

Our analysis showed that Kratom-associated adverse effects, including seizures, are becoming more common. For each patient reviewed, initial differentials did not include Kratom. No routine urinalysis detected Kratom-metabolites; therefore, patients underwent numerous additional tests. On average, patients spent 4 days hospitalized and received at least one type of imaging. Additionally, users tend to share characteristics: male, middle-aged, college educated, and middle class.

Kratom-induced seizures are underreported in the literature. Analysis of Poison Control Center calls from 2011-2017 yielded 113 reported seizures from 1174 Kratom exposures, significantly more than published reports. Kratom is not detected by urinalysis. Untargeted chromatography-mass spectrometry can detect Kratom, but this instrument is expensive. Similarly, there is not a hospital-grade disposable test for Kratom detection. In conclusion, developing a positive predictive algorithm using the characteristics of Kratom users can help suggest Kratom as a source for seizures. Creating a rapid test for Kratom or an algorithm would save hospitals money and shorten patients’ hospitalizations.