Generalized seizure is known as a dose-independent side effect of tramadol. The presented case is affected by complex partial seizures, following tramadol dependency. Brain magnetic imaging showed atrophy of left hippocampus, compatible with mesial temporal sclerosis. Mesial temporal sclerosis is the most common cause of treatment-resistant seizure with etiology of trauma, inflammatory processes, and recurrent seizures. It seems that recurrent generalized seizure by tramadol abuse is responsible for hippocampus atrophy, mesial temporal sclerosis, and complex partial seizures.