Fatigue is prevalent and disturbing, but largely an ignored symptom because it is not life threatening (23). Fatigue can cause severe disruption in the patient's ability to function and also affect multiple aspects of life. Fatigue can be mild to debilitating and is usually cum-mulative. It is often excessive in nature and is a whole body experience not relieved by sleep and is not always the result of activity. Fatigue is not predictable by tumor type, treatment, or stage of illness. High levels of fatigue impact on all aspects and correlate with impaired QOL (24). Fatigue may be one of the significant factors that limit a patient's QOL. Interventions include energy conservation, maintaining normal sleep-wake cycles, learning not to fight the fatigue, flexibility, preplanning, and setting limits and priorities to balance and organizing activities. Interventions such as exercise, yoga, meditation, prayer, walking, rest, and decreasing stimuli may help. Psychostimulants have been used to enhance cognition and memory, modulate behavior, and increase wakefulness and participation in activities of daily living in brain injured patients (19).

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