Nareka A. Trewick, MD
Resident Physician
University of Miami/Jackson Memorial Hospital
Miami, Florida, United States
Diana M. Molinares Mejia, MD
Attending Physician
Jackson Memorial Hospital/University of Miami
Miami, FL, Florida, United States
Laura Moralejo, BS
Medical Student
VCOM-Auburn
Miami, Florida, United States
Glioblastoma multiforme, hypoarousal This case highlights the importance of recognizing and addressing hypoarousal in patients with glioblastoma, and the potential role of modafinil as a treatment option in this population. By sharing our experience with this case, we hope to contribute to the growing body of literature on the rehabilitation of patients with brain tumors, increase support for family training as a primary role of inpatient rehabilitation and provide valuable insights for clinicians working with similar patients in the future.
Case Description: Glioblastoma is an aggressive form of brain cancer, typically with poor prognosis. Patients with this condition often experience cognitive and physical impairments, particularly in the setting of cranial surgeries, that require intensive physical rehabilitation to optimize functional outcomes. This is the case of a 68-year-old female with recent diagnosis of glioblastoma who was admitted to inpatient rehabilitation after craniotomy with brain mass biopsy and partial tumor resection. She presented with significant hypoarousal, which posed a major obstacle to family training as it made engagement with therapists and family difficult. The rehabilitation team pursued management with modafinil, a medication that is commonly used to treat excessive daytime sleepiness. In this setting of glioblastoma, modafinil proved to be effective in improving arousal and cognitive function, allowing our patient to fully participate in rehabilitation with a primary goal of family training.
Discussions: In this case report, we describe the patient's clinical presentation, their rehabilitation course, and the improvement of their outcomes after treatment with modafinil. We discuss the challenges and considerations that were involved in medically managing hypoarousal in this patient given her concurrent need for keppra as seizure prevention and ongoing dexamethasone taper for cerebral edema. In addition, we discuss the critical role of inpatient rehabilitation in patients with poor prognosis, such as those with glioblastoma, highlighting the value of family training.
Conclusions:
