Areca catechu (palm tree) nut chewing and seizures: An observational study

The objective of this study was to report the impact of chronic abuse of Areca catechu nut wrapped in leaf (also known as doma, quid, paan), the fourth most commonly abused psychoactive substance worldwide, on the frequency of seizures among people with epilepsy. People with clinically diagnosed epilepsy (>14years old) residing in the Kingdom of Bhutan were surveyed for self-reported Areca catechu use, demographic variables, epilepsy characteristics, and seizure frequency. The relationship between seizure frequency in the prior month and chewing Areca catechu, adjusted for various confounders, was analyzed using multivariable regression models. There were 152 people with epilepsy, including 50 chewers (33%) and 102 (67%) nonchewers. The median duration of chewing A. catechu was 62months (25th, 75th percentiles: 24, 120months). Chewers consumed an average of three nuts daily. There was no significant difference between chewers and nonchewers in the mean age, proportion of male vs. female, age at first epileptic seizure, or number of antiepileptic drugs presently taken; chewers were more likely to be rural dwellers (p=0.042). After adjustment for all of the above variables, on average, chewers had 58.7% fewer [95%CI: (−79.4, −17.0)] seizures in the prior month, equating to 2.1 fewer [95% CI: (−3.9, −0.3)] seizures. Our observational study suggests that the social custom of chewing Areca catechu nut is associated with reduced seizure frequency among people with epilepsy. This association may be due to its natural stimulant properties, a novel antiepileptic property of the nut, or has another, yet unknown explanation. •Areca catechu nut (betel quid) is chewed by >600 million people worldwide.•In our study, people with epilepsy in Bhutan chewed an average of three nuts daily.•Areca chewers had 59% fewer seizures in the prior month compared to nonchewers.•Areca chewers vs. nonchewers had approximately two fewer seizures in the prior month.•The social tradition of Areca chewing may have beneficial impact on seizure frequency.