Kratom Use Triggers Breakthrough Seizures in Epilepsy Patients

Why it matters

People with epilepsy who use kratom may be putting themselves at serious risk — this case series documents breakthrough seizures in controlled epilepsy patients after starting kratom use, with seizures resolving after cessation.

The big picture

As kratom grows more popular for self-treating anxiety and opioid withdrawal, neurologists and epilepsy specialists need to screen patients for kratom use. The interaction with antiepileptic drugs may be underappreciated and potentially life-threatening.

Key findings

• • 3 cases of breakthrough seizures in patients with epilepsy associated with kratom use were documented at UPMC
• • Two patients had previously well-controlled epilepsy; seizures returned after starting daily kratom use and resolved after stopping
• • Seizure incidence with kratom use reported at 6.1–9.6% in US poison center data and up to 17.5% in Thailand
• • Kratom's pharmacology (opioid receptor agonism, adrenergic effects) may lower seizure threshold — mechanism remains under investigation
• • DEA listed kratom as a "drug of concern" following involvement in 150+ overdose-related deaths by 2017

Bottom line

Case series of 3 patients from outpatient neurology clinic; University of Pittsburgh Medical Center and VA Pittsburgh; published in Neurology: Clinical Practice (Feb 2021).