Tramadol has been classified as a controlled drug in several countries in recent decades due to increasing prevalence of abuse, overdose and its potential for adverse effects. Tramadol has been associated with multiple adverse effects including seizures, serotonin syndrome and even anaphylactoid reactions. Despite this it remains unregulated and is available over the counter in some countries. We describe two cases of tramadol-related seizures in patients prescribed therapeutic doses of tramadol, identified through neurology clinics at a neurology tertiary referral centre in Ireland. Literature review was carried out and revealed a significant lack of recent literature relating to Tramadol and risk of seizure. In particular, there was a lack of human studies investigating tramadol at therapeutic, rather than supra-therapeutic, doses. We suggest that further studies are required examining the use of therapeutic doses of Tramadol and its potential for adverse effects, looking particularly at seizure risk. We feel that Tramadol, like other opioids, can be useful as part of a multi-modal analgesia regimen in patients with moderate-to-severe pain, but that prescribers need to be more aware of the potential risk of seizures associated with prescribing it.