Tramadol-induced seizures and trauma

To determine the prevalence, type and site of the injuries due to tramadol-induced seizures in the patients who had referred after its overdose or use of its therapeutic dose.

All patients referring to Loghman Hakim Poison Hospital (February 2009 to April 2010) due to tramadol-induced seizures were included. The patients' data including age, gender, ingested dose by history, route of exposure, manner of poisoning, previous history of suicidal attempts, previous history of drug or substance abuse, history of tramadol abuse, type of the seizure, number of episodes of seizure before presentation or after admission, site of the trauma, and type of injury were recorded.

A total of 232 patients were included in the study. Of them, 185 (79.7%) had referred within the first 6 hours after ingestion. The mean dose ingested by the history was 1416 +/- 1124 mg. History of tramadol abuse was positive in 114 (49.1%) patients. Seizure episodes had occurred once in 207 (89.2%), twice in 21 (9.1%), and three times in 4 (1.7%) patients. The prevalence of trauma was 24.6% (in 57 patients) with the most frequent site of trauma to the face (9.5%) followed by shoulder (4.3%), head (3%), trunk (1.7%), and upper extremities (1.3%). No statistically significant difference was found between patients with and without trauma associated with tramadol-induced seizures in terms of age, gender, ingested dose by history, positive history of addiction to other opioids, and number of episodes of seizure.

The only serious injury associated with this type of seizure was the head injury, present in approximately 1% of the patients.