Reported Associations between Kratom and Seizures: A Systematic Review

Toby Turla^*Grayson AbeleMy HuaDennis Paustenbach

• TRC Companies Inc, Lowell, United States

Abstract: Kratom, derived from the leaves of the plant Mitragyna speciosa, is an herbal supplement that has been used medically and recreationally for centuries, but has recently gained popularity in the United States for its analgesic and euphoric effects. The United States Food and Drug Administration (US FDA) has issued warnings against the use of kratom due to potential health effects, including seizures. Seizures are one of the most commonly reported side effects associated with kratom use. The purpose of this paper is to determine whether a dose-relationship exists between kratom use and seizures. Methods: We conducted a non-systematic literature search to identify reviewed articles that contained information or data on kratom users experiencing seizures. Additionally, we mined adverse event data submitted to the Centers for Food Safety and Applied Nutrition's Adverse Event Reporting System (CAERS) database and the US FDA Adverse Event Reporting System (FAERS). These databases were selected to examine consumer-reported and healthcare-reported adverse events, providing a broader and comprehensive identification of seizure-related incidents potentially associated with kratom use. Data and Results: Our search yielded 42 articles, but only 11 met the criteria. These included case reports (n=6), case series (n=2), retrospective observational (n=2), and a summary of FAERS adverse events. The 11 publications involved 20 patients with seizures after kratom use, but only one was urine-tested for Mitragynine. The other 19 had no such testing. FAERS reported 22 seizures out of 481 kratom reports (4.5%), while CAERS reported 18 seizures among 221,178 incidents. No data on kratom quantity or confirmed use was available. Conclusion: Currently, the available literature primarily consists of a limited number of studies, including case reports and case series, which document self-reported kratom use and provide minimal quantitative toxicological data on mitragynine. Based on our narrative review, we conclude that there is insufficient evidence to suggest that kratom causes seizures, primarily due to the absence of a quantitative dose-response in toxicology reports and incomplete medical records.