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Suggest Ways To Treat Post-stroke Fatigue

Posted on Sat, 13 Jan 2018

Question: Hi, I am 37 years old and had a stroke in January of this year, SAH right frontal intracerebral hematoma effecting the Frontal, temporal and perinatal lobes. I refused medications such as baclofen while in hospital, after leaving hospital I asked my neurologist about modafinil for post-stroke fatigue, his reply was that they do not treat post-stroke fatigue, after some research I found out about Adrfinil and ordered some online. It worked wonders. Though i have started having seizures and was prescribed lamotragine and told to stop the Adrafinil. After two weeks of this I feel as though I am loosing my mind in cognitive decline. I am really unsure as what to do now.

Answered by Dr. Neeraj Kumar (46 minutes later)

Brief Answer:
Get evaluated by a neurologist and take treatment as advised

Detailed Answer:
Hello,
I have gone through your question and understand your concern.
Brain stroke leads to damage of nerves and associated stiffness in involved limbs.
The drugs like modafinil or armodafinil leads to Brain stimulation which can be harmful too.
I will not advice to continue adrfinil.
Lamotrigine as antiepileptics can lead to some impairment of memory. Even stroke may lead to some cognitive decline.
You should take drugs as advised by neurologist.
Lacosamide or oxcarbazepine can be used for seizures.
Baclofen can be used in low doses for spasticity.
Regular Physiotherapy is helpful.
Hope you found the answer helpful.
Do get back to me for further information.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Neeraj Kumar (49 minutes later)

Thank you for you reply, I found it useful, however having done mountains of research I thought that nootropics would help with the cognitive decline? I have also tried Phenylpiracetam and cdp choline though I did not notice as much benefit as adrafinil. I understand that overstimulation would not be a good thing, though cognitive decline is unacceptable to me. I have been looking into cerebrolysin and semax, if you have any knowledge of these things?

Kind regards,
xxxx xxxxxxxxxxxx

Answered by Dr. Neeraj Kumar (18 hours later)

Brief Answer:
Take treatment as advised

Detailed Answer:
Hello,
Nootropic agents are widely available with mild effect and is not grade A evidence based.
Piracetam can be taken.
Cerebrolysin is new drug which has been indicated in multiple brain pathology but benefits are mild.
Get vitamin B12 and thyroid levels checked to rule out any deficiency which is correctable.
Regards
Dr N Kumar

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Neeraj Kumar (1 hour later)

Thank you, very helpful. Do you think it could be onset of akathisia/dystonia?
Regards,
xxxx xxxxxxxxxxxxx

Answered by Dr. Neeraj Kumar (23 hours later)

Brief Answer:
Clinical examination required for diagnosis

Detailed Answer:
Hello,
The symptoms of akathesia or dystonia can only be diagnosed based on clinical examination.
Video maybe helpful.
Regards
Dr N Kumar

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Above answer was peer-reviewed by : Dr. Vaishalee Punj