Meperidine Induced Seizure in a Patient With Lyme Borreliosis

Abstract

A 15 years old child with Lyme borreliosis was treated with meperidine via a patient controlled analgesia (PCA) pump for pain management. He had no history of seizure and had normal hepatic and renal functions. At the 7th hour of meperidine PCA delivery, generalized tonic-clonic seizure was developed and successfully suppressed with antiepileptics and no neurologic sequel was occurred. The total meperidine consumption in the patient was quite lower than the recommended doses with PCA. Although Lyme disease might also cause seizure activities, the timing of the seizures was related with the accumulation of normeperidine which is the main metabolite of meperidine with central nervous system stimulant effect. The meperidine pain management on patients with Lyme syndrome should be reconsidered to avoid undesired effects.Keywords

Seizures and Meperidine: Overstated and Underutilized

“…Ten of the 50 reported patients (20%) had renal impairment, and 3/50 patients (6%) had liver impairment. Other confounding conditions included alcohol abuse (Danziger et al, 1994;Marinella, 1997), infection (Rodman and Maxwell, 1994;Knight et al, 2000;Hubbard and Wolfe, 2003;Eker et al, 2009), prior seizure history (Hochman, 1983;Stone et al, 1993), sickle cell disease (Pryle et al, 1992;Hagmeyer et al, 1993;Liu et al, 1994;Rodman and Maxwell, 1994;Nadvi et al, 1999;Dunwoody et al, 2006), and malignancy (Szeto et al, 1977;Kaiko et al, 1983;Armstrong and Bersten, 1986). One patient had Alzheimer's disease (Nagler et al, 2008), one had hereditary coproporphyria (Deeg and Rajamani, 1990), and one had severe burns and hyponatremia (Kyff and Rice, 1990).…”