title: Seizures and Meperidine: Overstated and Underutilized.
abstract: Meperidine is used for pain control and treatment of shivering. Concerns about neurotoxicity, particularly seizures, have led to efforts limiting meperidine use. We reviewed the body of evidence linking meperidine to seizures. We searched PubMed for the terms meperidine, normeperidine, pethidine, and norpethidine; each was combined with the terms: seizure, epilepsy, epileptogenic, toxicity, overdose, seizure threshold, and convulsion. Articles were assessed for relevance. Semiologies were reviewed to ascertain seizure likelihood. Our search yielded 351 articles, of which 66 were relevant. Of these, 33 had primary clinical data on meperidine-associated seizures, comprising 50 patients. Twenty events were deemed likely to be seizures, 26 indeterminate, and 4 unlikely. Most studies were case reports. Confounding comorbidities were frequent. The evidence base for meperidine-associated seizures in man is scant. Seizure risk associated with meperidine appears to be overstated. The utility of meperidine should continue to be explored, especially for therapeutic hypothermia.
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Konrad H
authors.initials: KH
authors.lastname: Schlick
authors.affiliation: 2 Department of Neurosciences, University of California San Diego , San Diego, California.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Hemmen
authors.affiliation: 1 Department of Neurology, Cedars-Sinai Medical Center , Los Angeles, California.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Lyden
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D006801:Humans; D008614:Meperidine / Q000009:adverse effects*; D017288:Pain Threshold / Q000187:drug effects*; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000139:chemically induced* / Q000175:diagnosis; D012768:Shivering / Q000187:drug effects*
chemical_list: D000701:Analgesics, Opioid; D008614:Meperidine