Systematic Review: Chronic High-Dose Kratom Use May Trigger Seizures — and Stopping It Is Often the Cure

Why it matters

As kratom use expands worldwide, emergency physicians and neurologists are beginning to encounter patients with seizures linked to the plant — but until now, there has been no systematic review of this specific neurological risk.

The big picture

Researchers at Chulalongkorn University in Bangkok conducted the first systematic review of published case reports of kratom-associated seizures. The review identified 21 patients across 11 publications, finding that chronic, high-dose kratom use — especially when combined with other drugs — is associated with generalized tonic-clonic seizures. Critically, stopping kratom led to seizure resolution in the majority of cases. The review was published in Public Health Toxicology in September 2025.

Key findings

• 21 patients across 11 publications (10 case reports and 1 case series) experienced seizures linked to kratom use
• Generalized tonic-clonic seizures were the most common type observed
• 71% of cases involved polysubstance co-ingestion, including opioids, benzodiazepines, stimulants, and alcohol
• Kratom cessation was linked to seizure resolution or significant improvement in at least 8 of 11 studies
• One case involved a neonatal seizure within 24 hours of birth following in utero kratom exposure throughout pregnancy
• Doses associated with seizures ranged from approximately 20 g/day to more than 100 g/day in documented cases

What they say

"Clinicians should routinely inquire about kratom and other herbal products when evaluating new-onset seizures," the authors wrote. "While evidence from case studies is limited and often confounded, this review suggests kratom use may be associated with seizure activity, especially in vulnerable populations or those with polysubstance use."

Bottom line

The first systematic review of kratom-associated seizures finds that chronic, high-dose kratom use — particularly with other substances — can cause generalized seizures, and stopping kratom is a critical component of effective management.