Tramadol is a centrally acting synthetic opioid that is widely used for its analgesic effect. Tramadol abuse is increasing in Egypt, and seizure is possible among abusers. Hence, the aim of this study was to evaluate the characteristics of acute tramadol overdosed patients and the possibility of prediction of seizures among them. Fifty participants were recruited from acutely intoxicated tramadol patients admitted to the Poison Control Center (Emergency Hospital, Tanta University) between January, 2014 and December, 2015. For each patient history, clinical data and tramadol blood level as well as urine screen were recorded. The study showed a significant difference between different groups of age, gender, tramadol dose and period of hospital stay. The majority of cases were males, between 15 and 25 years-old, who ingested a dose ranging from 1000 to 3000 mg and stayed for less than 10 hours in the hospital. The occurrence of seizures was higher among patients exposed to a tramadol dose more than 1000 mg, those who developed hyper-reflexia and those with higher blood tramadol levels. At a cut off value >600 ng/ml, blood tramadol level had a sensitivity of 73.91%, a specificity of 74.91%, positive predictive value of 70.83% and negative predictive value of 76.92%. It could be concluded that hyper-reflexia, the amount of tramadol taken and tramadol blood concentration could be used to predict the development of seizures among tramadol overdosed patients.