Chronic tiredness is a common and challenging experience for people living with epilepsy. This persistent exhaustion is reported by a significantly higher percentage of those with epilepsy compared to the general population. The reasons for this weariness are complex, stemming from a combination of direct neurological events, side effects of treatment, and co-occurring health conditions. Understanding these factors is the first step toward managing the pervasive feeling of being tired all the time.
Exhaustion Following a Seizure
The acute, intense fatigue immediately following a seizure is a direct result of a neurological energy drain. A seizure is a period of uncontrolled, high-frequency electrical activity that drives the brain into a state of extreme metabolic demand. During this hyperactive phase, the brain consumes oxygen and glucose at an accelerated rate.
The sustained neuronal firing rapidly depletes the brain’s main energy molecule, Adenosine Triphosphate (ATP), and its reserve, phosphocreatine. This sudden energy deficit is comparable to the physical exertion of a marathon runner, leaving the person exhausted in the post-ictal period. The body and brain require time and rest to restore these depleted energy reserves and return to a normal metabolic state.
How Anti-Seizure Medications Contribute
Anti-Seizure Medications (ASMs) reduce the excessive electrical excitability of nerve cells in the brain, which causes a central nervous system (CNS) depressant effect. This therapeutic mechanism often translates into side effects such as drowsiness, cognitive slowing, and chronic fatigue. The degree of tiredness depends on the specific drug, the dosage, and the patient’s individual sensitivity.
ASMs that enhance the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) tend to cause more sedation because they broadly quiet brain activity. Other medications, like levetiracetam, are associated with noticeable fatigue, even when the underlying mechanism is not purely GABA-related. Furthermore, polytherapy, which involves taking multiple ASMs simultaneously, can intensify these sedating effects.
Tiredness caused by medication is often chronic, persisting long after the body has adjusted to the drug. Patients experiencing this side effect should discuss it with their neurologist, as a change in dosage or a switch to a less sedating medication may be possible. The goal is to find a balance between preventing seizures and maintaining an acceptable quality of life.
Sleep Quality and Mental Health Links
Persistent tiredness in epilepsy is often driven by factors beyond the seizure or medication side effects, particularly poor sleep quality and mental health comorbidities. Epilepsy has a bidirectional relationship with sleep: seizures can disrupt sleep, and poor sleep can lower the seizure threshold. Nocturnal seizures, even those a person does not remember, frequently interrupt sleep cycles, preventing the restorative deep sleep phase.
Epilepsy also co-occurs with primary sleep disorders at a higher rate than in the general population. For instance, Obstructive Sleep Apnea (OSA), a condition that causes repeated breathing interruptions during sleep, is found in a significant percentage of people with epilepsy and leads to chronic daytime sleepiness. Conditions such as Restless Legs Syndrome also contribute to fragmented, non-restorative sleep, leaving the person fatigued.
Mental health conditions like depression and anxiety are major drivers of chronic fatigue and are highly prevalent in the epilepsy community. Depression is strongly correlated with feelings of exhaustion, and studies indicate that many people with epilepsy who report fatigue also meet the criteria for depression. This creates a difficult cycle: depression causes fatigue, which can increase seizure vulnerability, and the resulting seizures then contribute to more fatigue and worsened mood.
Practical Steps for Reducing Tiredness
Managing chronic fatigue begins with an open discussion with a healthcare provider to identify the root cause. A physician can review the current ASM regimen to see if a less sedating drug or a dosage adjustment is possible. They can also screen for non-epilepsy causes of fatigue, such as thyroid issues, anemia, or vitamin deficiencies.
Establishing strict sleep hygiene is a strategy for improving energy levels. This involves going to bed and waking up at the same time every day, even on weekends, and ensuring the sleep environment is cool, dark, and quiet. Avoiding caffeine, heavy meals, and screens close to bedtime helps regulate the body’s natural sleep-wake cycle.
Incorporating regular, moderate physical activity, such as a daily walk, can help combat exhaustion. Tracking seizures, sleep patterns, and daily energy levels in a diary can reveal personal triggers and patterns, providing valuable information for the medical team to tailor treatment. Because mental health is closely linked to fatigue, actively treating symptoms of depression or anxiety through therapy or appropriate medication can break the exhaustion cycle.