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
Highlights
Lyme borreliosis is a tick-borne spirochetal infection with Borrelia burgdorferi which affects the skin, joints, heart and nervous system
We described the case of generalized tonic-clonic seizures induced by patient controlled analgesia (PCA) with meperidine for pain management due to tonic spasms secondary to demyelination in a 15 year-old patient with Lyme syndrome who had no seizures during the initial examinations
Lyme borreliosis is a multisystem disease associated with cranial nerve palsies, peripheral and cranial radiculopaties, aseptic menengitidis, encephalatic symptoms, seizures and demyelinating polyneuropathy
Summary
Lyme borreliosis is a tick-borne spirochetal infection with Borrelia burgdorferi which affects the skin, joints, heart and nervous system. A 15 years old child with Lyme borreliosis was treated with meperidine via a patient controlled analgesia (PCA) pump for pain management. 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.
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