2025 Southeastern Residency Conference

Title: Effects of Tramadol on Seizure Incidence in Traumatic Brain Injury Rehabilitation Inpatients 


Authors: Sasha Rehmani, Elisabeth Webb, Dina Nakhleh, Raeda Anderson, Chloe Sellers, Carly Warner


Background: The increased risk of seizure in patients who have suffered a traumatic brain injury (TBI) is well-documented and tramadol carries a warning for seizure risk. Research exists on whether tramadol can increase the risk of new onset seizures in the general population. However, there is little information characterizing the effects of tramadol specifically in TBI inpatients in rehabilitation settings. This study fills this gap in literature by retrospectively evaluating TBI rehabilitation inpatients. The primary objective evaluates the effect of tramadol use on seizure incidence in TBI inpatients compared to TBI inpatients who did not receive tramadol.


Methods: This study is a retrospective, single-centered cohort study focused on brain injury rehabilitation inpatients admitted and discharged between July 1, 2021 and June 31, 2024. Inclusion criteria are patients over 18 admitted with a TBI or disorder of consciousness. Exclusion criteria are patients who are pregnant, history of seizure disorder before injury, and dual spinal cord and brain injury. For inpatients who met inclusion criteria, baseline characteristics, seizure occurrence, and inpatient medication history data were collected via EPIC. Qualifying TBI inpatients who received tramadol during their admission were compared to inpatients who did not receive tramadol and incidence of seizure was evaluated in each group. Secondary objectives analyzed both the use of seizure threshold-lowering medications and tramadol on seizure incidence and the impact of antiseizure medications and tramadol on seizure incidence. Analysis of baseline characteristics was conducted with descriptive statistics. Analysis of primary and secondary endpoints was conducted using cross-tabulation with a chi-squared test and a gamma test to check the association and direction of association between the sets of variables. Additional analysis using odds ratio logistic regression was conducted. This study was approved by the Institutional Review Board.


Results: A total of 477 patients (mean age =38.18, SD =16.76) were included in this study. The sample was predominately White (77.6%) and male (78.2%). 38.6% of patients received tramadol during their inpatient stay. There was no significant relationship between the use of tramadol and the likelihood of an inpatient having a seizure at Shepherd Center. Only 6.3% of patients had a seizure during their inpatient stay, of which 2.9% did use tramadol and 3.4% did not. There was a nonsignificant association (p = 0.139) between the use of tramadol, use of other seizure threshold lowering medications, and the incidence of a seizure.  There was a significant, strong, positive correlation (Γ = 1.0, p=<0.001) between taking any antiseizure medication and the event of a seizure for patients who do receive tramadol. There was also a significant, strong, positive correlation (Γ= 0.928, p=<0.001) between taking any antiseizure medication and the event of a seizure for patients who do not receive tramadol.


Conclusion: This study found no significant effect of tramadol use on seizure incidence in TBI inpatients compared to TBI inpatients who did not receive tramadol. These findings suggest that tramadol may be a safe and effective option for pain relief in TBI rehabilitation inpatients. Further research could improve methodological rigor by using randomized controlled trials.