Document Type : Original Article
Assistant professor of radiology, department of radiology, Mashhad university of medical sciences, Mashhad, Iran
Mashhad University of Medical Sciences, Mashhad, Iran
Assistant Professor, Toxicology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Introduction: Recently tramadol intoxication and non-therapeutical abuse have been prevalent in Iran. in this study we aimed at evaluating possible central neural system lesions in patients with tramadol induced seizure by using MRI imaging.
Methods & Materials: a cross-sectional study was conducted with age- and sex-matched case and control groups. The case group included oral tramadol intoxication cases with loss of consciousness and/or tramadol induced seizure. The control group included patients with seizure without tramadol consumption. In the first post seizure 24-hour, brain MRI was done and the images were interpreted by a radiologist. Finally all data were collected and they were recorded and analyzed using SPSS software.
Results: 15 patients (7 females and 8 males) were in the control group and 15 patients (3 females and 12 males) were in the case group with mean age of 22.27±6.54 and 21.93±4.57 years, respectively. 8 patients of case group and 3 patients of control group had abnormal evidences (hyper signal foci in white mtter) in brain MRI images; there were no significant difference between two groups (p=0.128). Lesions depth in MRI images of case group were equally in Subcortical and Deep parts of white matter (37.5%) and in 2 cases (25%) were observed in both parts. There was no difference between two groups in this way (p=0.721). The most common involved lobe in both groups was frontal lobe which was observed in 62.5% (5 patients) of case group and 100% (3 patients) of control group. In comparison between two groups there was no significant difference in involved lobe (p=0.509).
Conclusion: In our study, over half of case group patients had hypersignal evidences in MRI imaging. However no specific pattern was seen in these lesions. Also no significant difference was observed between case and control groups in lesions pattern.
- Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL. Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an 'atypical' opioid analgesic. The Journal of pharmacology and experimental therapeutics. 1992;260(1):275-85.
- Nikfar S, Kebriaeezadeh A, Majdzadeh R, Abdollahi M. Monitoring of National Drug Policy (NDP) and its standardized indicators; conformity to decisions of the national drug selecting committee in Iran. BMC international health and human rights. 2005;5(1):5.
- Shadnia S, Soltaninejad K, Heydari K, Sasanian G, Abdollahi M. Tramadol intoxication: a review of 114 cases. Human & experimental toxicology. 2008;27(3):201-5.
- Dayer P, Collart L, Desmeules J. The pharmacology of tramadol. Drugs. 1994;47 Suppl 1:3-7.
- Jick H, Derby LE, Vasilakis C, Fife D. The risk of seizures associated with tramadol. Pharmacotherapy. 1998;18(3):607-11.
- Atici S, Cinel L, Cinel I, Doruk N, Aktekin M, Akca A, et al. Opioid neurotoxicity: comparison of morphine and tramadol in an experimental rat model. International Journal of Neuroscience. 2004;114(8):1001-11.
- De Decker K, Cordonnier J, Jacobs W, Coucke V, Schepens P, Jorens PG. Fatal intoxication due to tramadol alone: case report and review of the literature. Forensic science international. 2008;175(1):79-82.
- Boostani R, Derakhshan S. Tramadol induced seizure: A 3-year study. Caspian journal of internal medicine. 2012;3(3):484-7.
- Boostani R, Derakhshan S. Tramadol induced seizure: A 3-year study. Caspian journal of internal medicine. 2012;3(3):484.
- Márquez-Romero J, Zermeño-Pohls F, Soto-Cabrera E. Convulsive status epilepticus associated with a tramadol overdose. Neurología (English Edition). 2010;25(9):583-5.
- Sen H, Ozkan S, Dagli G. Epileptic seizure during patient-controlled analgesia with tramadol. European Journal of Anaesthesiology (EJA). 2009;26(5):447.
- Tanne C, Javouhey E, Millet A, Bordet F. Severe tramadol overdoses in children: a Case series admitted to paediatric intensive care unit. Journal of Clinical Toxicology. 2016;6(5):1000317.
- Talaie H, Panahandeh R, Fayaznouri MR, Asadi Z, Abdollahi M. Dose-independent occurrence of seizure with tramadol. Journal of medical toxicology. 2009;5(2):63-7.
- Petramfar P. Tramadol induced seizure: Report of 106 patients. Iranian Red Crescent Medical Journal. 2010;2010(1):49-51.
- Alaee A, Zarghami M, Farnia S, Khademloo M, Khoddad T. Comparison of Brain White Matter Hyperintensities in Methamphetamine and Methadone Dependent Patients and Healthy Controls. Iranian Journal of Radiology. 2014;11(2).
- Lyoo IK, Streeter CC, Ahn KH, Lee HK, Pollack MH, Silveri MM, et al. White matter hyperintensities in subjects with cocaine and opiate dependence and healthy comparison subjects. Psychiatry Research: Neuroimaging. 2004;131(2):135-45.
- Daubin C, Quentin C, Goullé J-P, Guillotin D, Lehoux P, Lepage O, et al. Refractory shock and asystole related to tramadol overdose. Clinical toxicology. 2007;45(8):961-4.
- Jovanović-Čupić V, Martinović Ž, Nešić N. Seizures associated with intoxication and abuse of tramadol. Clinical toxicology. 2006;44(2):143-6.
- Afshari R, Ghooshkhanehee H. Tramadol overdose induced seizure, dramatic rise of CPK and acute renal failure. JPMA The Journal of the Pakistan Medical Association. 2009;59(3):178-.
- Marquardt KA, Alsop JA, Albertson TE. Tramadol exposures reported to statewide poison control system. Annals of Pharmacotherapy. 2005;39(6):1039-44.