Blog # 156: Fatigue and Epilepsy

 

BJ Mac, Medical and Health Writer, and neurologist,  Amit M. Shelat, D.O., reviewed this subject in 2021 and their observations will help explain common symptoms with your epilepsy.¹

Added to your epilepsy, you feel exhausted, tired, or weak. Fatigue is a much more common symptom in people living with epilepsy than in the general population. Feelings of exhaustion and weakness can affect daily quality of life. Understanding this, there are some ways to help manage epilepsy-related fatigue.

What Does Fatigue with Epilepsy Feel Like?

The fatigue felt by people living with epilepsy is characterized by mental and physical experiences of persistent and extreme weakness, tiredness, and exhaustion.

One patient described being more emotional because of fatigue: “Does anyone feel so tired that they feel sad? This often happens to me. I am on a lot of medication, and my seizures are not under control, so I guess I have many reasons to be tired.”

Another patient reported that fatigue causes daytime sleepiness: One patient described the impact of seizure-related fatigue on her quality of life, writing, “For several years, I wake up after a seizure, and I am tired for up to seven days and in bed pretty much all day every day. That is the primary reason I lost my job.”

What Causes Fatigue in Epilepsy?

Several factors can cause a person with epilepsy to experience fatigue.

Depression

Depression is a known comorbidity (co-occurring condition) of epilepsy, with symptoms that vary from person to person. A study² using measures called the Fatigue Severity Scale and Fatigue Impact Scale revealed a high prevalence of depression-related fatigue among people living with epilepsy.

This fatigue may sometimes trigger epileptic seizures. A cycle can start to develop: Depression causes fatigue, which contributes to seizures. These seizures then cause more fatigue, which contributes to depression, and so on. Talk to your doctor about how to treat depression to break this cycle.

Many patients agree that dealing with depression is a common aspect of living with epilepsy: “I never thought I would ever have to deal with depression. With epilepsy, depression is a daily battle.”

Nocturnal Seizures

Another important risk factor of developing fatigue when living with epilepsy is poor sleep or sleep impairment. Nocturnal seizures (seizures that occur while a person is sleeping) can affect a person’s sleep quality.

A person is considered to have nocturnal seizures if more than 90 percent of their seizures occur when sleeping, which is the case in up to 45 percent of people living with epilepsy.

Both generalized and focal seizure types can occur as nocturnal seizures. Nocturnal seizures tend to occur during the first, lighter stages of sleep or upon waking.

One patient described nighttime seizures as a source of fatigue: “I recently had several nocturnal seizures, and I am now very exhausted. It will take three days for my body to get back to normal. It takes so much out of you.”

Another person described how nocturnal seizures interrupt her sleep rhythm and cause fatigue the next day: “Does anyone else ever have a seizure in their sleep and find it hard to fall back asleep? Then during the day, it can completely take your energy away.”

Postictal Fatigue

There are several stages to a seizure:

• Prodromal phase — When symptoms begin.
• Aural phase — When altered perception or sensations occur.
• Ictal phase — The actual seizure.
• Postictal phase — Recovery time after a seizure.
• Interictal phase — The time in between seizures.

Postictal phases have been found to have higher chronic fatigue scores and fatigue impact scores than ictal phases, with people reporting more fatigue and lower energy during the postictal phase. In other words, the recovery period after a seizure is a time of intense fatigue.

Many people reported needing to sleep due to intense fatigue during this phase. “I always go to sleep after a seizure,” wrote one patient. “It’s often compared to running a marathon. Your muscles are weak, everything hurts, and you are plain tired.”

Antiseizure Medications

Antiepileptic drugs commonly cause fatigue. A change of medication or time to adjust to your treatment plan may be needed to reduce this fatigue.

One patient said about medication-related fatigue: “When I took that medication, I experienced fatigue, anxiety, fear, anger, and mood swings.” Offering some great advice: “When side effects become unmanageable, it’s time to talk to your neurologist and ask for a drug that has fewer side effects.”

Managing Epilepsy-Related Fatigue

Managing fatigue with epilepsy can be challenging because its different causes can be interrelated. Tracking symptoms of fatigue and discussing causes and treatments with your health care team is the best place to start.

1)     BJ Mac, Medical and Health Writer, Medically reviewed by
Amit M. Shelat, D.O. 2021

2)     Fatigue in epilepsy: A systematic review and meta-analysis Oh-Young Kwona , Hyeong Sik Ahnb , Hyun Jung Kimb, * a Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea b Institute for Evidence-Based Medicine, Korea University College of Medicine, Seoul, Republic of Korea

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.