Tramadol-associated seizures in Egypt: Epidemiological, clinical, and radiological study

Tramadol intake related seizures have emerged as a common cause of seizures in Egypt affecting mainly young men.

This study aimed to determine the percentage of tramadol induced seizures, and to compare the clinical, neurophysiological, and radiological features of tramadol induced seizures group with idiopathic epilepsy group.

Two phases study; at first phase, data analysis for all Kasr-Alainy epilepsy clinic patients in Cairo during the period from January 2012 through June 2014, then at second phase a group of tramadol induced seizures' patients were compared with a matching group of idiopathic epilepsy patients. Detailed history and examination, laboratory tests, electroencephalogram (EEG), Magnetic Resonance Imaging (MRI) of the brain, and Hamilton depression rating scale (HAM-D) were performed for both groups.

Tramadol induced seizures represented 7% of all patients (103 out of 1480) and 12% of male patients. All cases were males. Occupational driving was the most common job. Seizures were generalized tonic clonic (GTCs) in 86%. Seventy-seven percent of tramadol induced seizures developed with toxic tramadol dose (>400 mg/day). Inter-ictal EEG was normal in most patients (87.5%). Depression and EEG abnormalities were significantly less than idiopathic epilepsy patients. MRI brain for both groups was normal.

Tramadol induced seizures represented 7% of cases. This deviates the attention to the problem of tramadol addiction in Egypt and raises our awareness of tramadol induced seizures.