Meperidine induced seizure in a patient with lyme borreliosis

Area of Science:

• Neurology
• Pharmacology
• Infectious Diseases

Background:

• Lyme borreliosis is a tick-borne illness that can present with various neurological symptoms.
• Pain management in pediatric patients with Lyme disease often involves analgesics like meperidine.
• Patient-controlled analgesia (PCA) allows patients to self-administer pain medication.

Observation:

• A 15-year-old patient with Lyme borreliosis developed generalized tonic-clonic seizures during meperidine PCA treatment.
• Seizures occurred despite normal hepatic and renal function and relatively low meperidine consumption.
• The patient had no prior history of seizures.

Findings:

• The seizures were temporally associated with meperidine administration via PCA.
• Normeperidine, a CNS stimulant metabolite of meperidine, is implicated in the seizure activity.
• The accumulation of normeperidine likely caused the seizures, despite low total meperidine dose.

Implications:

• This case highlights a potential risk of meperidine-induced seizures in patients with Lyme borreliosis.
• Reconsideration of meperidine for pain management in Lyme syndrome is advised to avoid neurotoxic effects.
• Further research into safe and effective analgesia for Lyme disease patients is warranted.