Asked by

Spouse EXTREMELY tired (astrocytoma grade 2) Do you have recommendations for combating some of the fatigue?

My spouse is taking 3-5 hour naps and sleeping 7-8 hours. He is on week 6 of radiation and TMZ, and is on Keppra (2000mg) and Vimpat (400mg). He had a focal seizure last week so they decided to add the Vimpat. He had a craniotomy in the beginning of August with maximal resection, but had an epidural hematoma after the surgery - so needed an emergency evacuation. His midline shift was 14mm (since resolved).  He also nods off on the way to radiation and back. He's difficult to wake up from his naps, or from regular sleep. He can be a little confused, but says that overall he just feels the most exhausted he has ever felt in his life. He's also been telling me how it's been depressing him because he feels like he can't do anything.

Do you have recommendations for combating some of the fatigue?


So sorry to hear your spouse is going through all of this. Depending on his history - when did it start, how much worse has it become recently (and any relationship with the addition of the new medication, etc.) the sleepiness and fatigue can definitely have multiple possible causes, including the radiation, the anti-seizure medicines, and his primary situation (post-surgery). I agree with you that he should definitely seek further guidance from his medical team - especially the neurosurgeon, oncologist (or whoever has prescribed the TMZ), and neurologist (or whoever prescribed the anti-seizure meds) - basically as many doctors as are involved in his care. 

I see that the dosing for Vimpat as a combination (Keppra) starts at 50mg twice a day (adult tab for I suspect in an effort to get control of the seizures, the doctors went 'all out' at the cost of causing excessive sleepiness. Hopefully, they can guide you further, make sure it is nothing serious, and get him to a place where the seizures are controlled and he does not feel overly tired. 

I hope he is able to get some resolution to this situation soon and encourage you to continue advocating for him!

Best Wishes,
Jason Sager, MD