Seizures and Meperidine: Overstated and Underutilized.

Area of Science:

• Pharmacology
• Neuroscience
• Clinical Toxicology

Background:

• Meperidine is utilized for pain management and to control shivering.
• Concerns regarding meperidine's neurotoxicity, specifically its association with seizures, have prompted restrictions on its clinical use.

Purpose of the Study:

• To systematically review and evaluate the existing evidence linking meperidine use to seizure activity.
• To assess the actual risk of seizures associated with meperidine administration.

Main Methods:

• A comprehensive literature search was conducted on PubMed using terms related to meperidine (and its metabolite normeperidine) and seizure-related concepts.
• Relevant articles were assessed for clinical data, and seizure likelihood was determined based on reported semiologies.
• Studies with primary clinical data on meperidine-associated seizures were analyzed.

Main Results:

• The review identified 351 articles, with 66 deemed relevant, including 33 studies with primary clinical data on 50 patients.
• Of the assessed events, 20 were likely seizures, 26 indeterminate, and 4 unlikely.
• The majority of evidence comprised case reports, often with confounding comorbidities.

Conclusions:

• The existing body of evidence directly linking meperidine to seizures in humans is limited and often based on case reports.
• The perceived risk of meperidine-induced seizures appears to be exaggerated.
• Further investigation into the therapeutic applications of meperidine, particularly in the context of therapeutic hypothermia, is warranted.