Abstract Details

Title Kratom-Induced Seizures Associated With Reversible Basal Ganglia T1 Hyperintensities on MRI

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 139

Objective

To report a case of bilateral tonic-clonic seizure and reversible basal ganglia T1 hyperintensity on MRI associated with kratom use.

Background Kratom (mitragynina speciosa) is a common herbal supplement used to treat a variety of clinical symptoms including pain and mood. Two compounds in kratom leaves, mitragynine, and 7-α-hydroxymitragynine, have been implicated in its therapeutic effect as a stimulant and analgesic. However, the exact mechanism of action remains uncertain, and there have been a number of safety concerns associated with kratom use, including reports of reports provoked seizures in patients with epilepsy and abnormalities on brain imaging.

Design/Methods NA

Results We report the case of a 33 year old Caucasian female with history of anxiety and depression who reported using kratom for 1-2 years at a dose of up to 12.5 grams three times daily. She had her first lifetime seizure after missing one dose of kratom for a medical procedure. MRI revealed uniform bilateral basal ganglia T1 hyperintensities. The patient did not have any known symptoms suggestive of underlying movement or neurodegenerative disorder. There was no other exposure to toxic or recreational substances. Serum and urine heavy metal screen, serum paraneoplastic panel, and autoimmune workup were negative. She did not have any further seizures after stopping kratom and starting lamotrigine (LTG). Twenty-four hour ambulatory EEG six months after stopping kratom revealed rare left frontal epileptiform discharges. Repeat MRI imaging one year following her seizure showed resolution of the basal ganglia T1 hyperintensities.

Conclusions To our knowledge, this is the first report of reversible changes on imaging associated with kratom use. The constellation of seizures and reversible T1 basal ganglia changes on MRI may be features of kratom use.

Authors/Disclosures
Erik Valenti, MD (Saint Alphonsus Medical Group Neurology) PRESENTER	Dr. Valenti has received personal compensation in the range of $0-$499 for serving as a Consultant for LVIS.
	No disclosure on file
Paul V. Motika, MD (Oregon Health and Science University)	Dr. Motika has nothing to disclose.

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Abstract Details