Have you ever seen chronic comotase like fatigue with severe pain upon awakening?

Have you ever seen chronic comatose fatigue with pain? Where the person just turns off like a comatose effect and when they are awake they are in severe pain. All vital symptoms are normal and they clearly need help and medications. First this fatigue / comatose effect is like a mini brain seizure that turns the person off and puts them into a comatose state and when they are awake they are exhausted with pain, headaches dizziness and vertigo. MRi scan returned normal. Patient did have glandular fever and a fall. What medications would be a good first try? Suggestions like: Lyrica (pregabalin)?, Neurontin?, SSRi, SSNRi or other? Also if it is some kind of a mini brain seizure that is causing the comatose fatigue is it true that certain supplements should be ad voided like Tyrosine? Caffeine? Ginko Biloba? Alcohol? And all Stimulants? Thanks for all your work.

Answer

Hard to say as this would be very unusual, but the neurologist may consider sequentially using anti epileptic drugs and I would check vitamin B12 levels (keep over 540), and magnesium (keeping blood levels over 1.9) for starters . An EEG during one of the episodes would add a lot of info as would an arterial blood gas checking for hyperventilation and hypoventilation (must be done during the "turning off" part of the episode). If hyperventilation, when very severe I have seen it drop magnesium levels low enough to trigger tetany. But given the complexity, the person needs to be addressed by a neurologist.

L&B,
Dr. T