Objective: The authors aimed to describe the substances involved in those young people with seizures and to characterize their clinical presentation, clinical course as well as management in the Emergency Department [ED] and their outcomes.
Materials and Methods: This was a retrospective study. Patients aged 10 to 26 years from September 2011 to November 2013 with substance related seizures were included. The authors excluded those with a history of severe head injury within one month, suspected alcohol withdrawal, and prior history of a known cause of seizures. Two independent ED nurses abstracted the data. Inter-rater reliability was tested and the kappa was 0.84.
Results: Over the 27-month-period, 56 cases aged 10 to 26 years with a history of seizure were included. Eighty percent were male. The median age was 17 years old. Almost 90% of patients ingested tramadol, mainly for recreational purposes. Half of them ingested tramadol alone, the other half ingested it in combination with promethazine (25%), hydroxyzine (16%) and diphenhydramine (5%). The median dose of tramadol was 400 mg. All seizures were generalized tonic clonic. Sixteen percent (6/37) had serotonin syndrome. Serum creatinine was found elevated in 28%. Plasma glucose was low in 2 cases. Most cases (77%) were observed in the ED (median 10 hours) and were discharged home safely without any unscheduled revisit or recurrent seizures.
Conclusion: Cases with tramadol-induced seizures were commonly seen among adolescents and young adults in Bangkok during the study period. Elevated serum creatinine level seemed relatively common.

Keywords: tramadol, recreational, serotonin syndrome, promethazine, prescription drug abuse