A case control study was conducted among 66 patients presented to Mansoura University Emergency Hospital following tramadol administration to investigate the nature of tramadol induced seizures, its correlation with ingested dose and the relation of drugs of abuse co-administration to seizures occurrence. Patients were divided into two groups: group I were patients presented with seizures and group II were patients presented without seizures. Among studied patients, there wasno significant statistical difference between the two groups in age and sex. Patients were presented with tonic clonic seizures within 30 minutes up to 10 hours post ingestion. The most frequent dose thatcould induce seizures was 500-1000 mg with the lowest reported dose inducing seizures was 225 mg. In addition, patients presented with history of administration of toxic dose (2250 mg) were presented without seizures. On correlating the dose with seizures occurrence, there was moderate positive correlation (p=0.01, r=0.343). The coadministrated drugs of abuse showed that opiates and cannabis co-administration with tramadol increases the risk of tramadol induced seizures three time. In conclusion, although there is positive correlation between seizures occurrence and the ingested dose, tramadol induced seizures is not dose dependent and it can occur on ingestion of therapeutic dose and persons with ingestion of toxic dose can be presented without seizures.