QL-07TREATMENT OF FATIGUE IN A PATIENT WITH CORPUS-CALLOSUM GLIOMA AND ATYPICAL SLEEP DISORDER

• Published in: Neuro-oncology (Charlottesville, Va.) Va.), 2014-11, Vol.16 (Suppl 5), p.v179-v179
• Main Authors: Butts, Alissa, Johnson, Derek, Brown, Paul, Cerhan, Jane
• Format: Article
• Language: English
• Subjects: Abstracts
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/nou269.7

We present the case of a 53 year-old married gentleman with above-average IQ who has a high-grade glioma of the corpus callosum, severe fatigue, cognitive concerns, and an atypical sleep disorder. He has had severe daytime somnolence and poor concentration since childhood, with normal nighttime sleep. Since his teens, he has had two hours of alertness in the morning, followed by disabling sleepiness for the rest of the day. Epworth sleepiness scores have been extremely high (20 to 24). Diagnoses of ADHD, narcolepsy, and idiopathic hypersomnia had been applied, but he has not met full diagnostic criteria. From 2007 to 2012, escalating doses of stimulant medication were utilized, with the best response ("can attempt some household tasks" and "approaching a normal life" per his wife) on 400 mg modafinil, and 456 mg methylphenidate (seven times the recommended maximum). This allowed him to stay awake for some normal activities such as attending his child's baseball game. In June of 2012, the modafanil and methylphenidate were discontinued by his doctor because the sleep disorder could not be confirmed with polysomnograph and multiple sleep latency testing. The somnolence returned, and the patient became distraught and expressed suicidal ideation. He saw a psychotherapist who referred him to Neurology where the corpus callosum glioma was identified incidentally (biopsy confirmed grade III astrocytoma). Pre-treatment neuropsychological evaluation revealed impairment on digit-symbol coding (z= -2.0) and was otherwise normal. The tumor was treated with radiation and temozolamide, and is currently radiographically stable. Fatigue is an ongoing problem (Epworth = 17, he rates fatigue at 8/10). He takes 80 mg Adderall. He would like to resume the previous regimen and high dose of Ritalin. We explore practical and ethical considerations in the treatment of fatigue with special consideration for quality of life in the context of high-grade glioma.