Patricia Orme, MD
Pediatric Rehabilitation Medicine fellow
Spaulding Rehabilitation Hospital
Rose Valley, Pennsylvania, United States
Jennifer Wu, MD, PhD
Physician Investigator
Spaulding Rehabilitation Hospital
Boston, Massachusetts, United States
A16 year old male with a traumatic left sided subdural hematoma was initiated on donepezil on day 46 after his injury, while admitted to inpatient rehabilitation, for significant memory impairments. Repeat cognitive impairment evaluations were performed while inpatient and on outpatient follow up (now 2.5 years after injury), demonstrating improvements on cognitive testing including trail making, Montreal Cognitive Assessment (MoCA), and Orientation Log (O-log). Importantly, no adverse side effects from donepezil were reported. Patient did trial a period of discontinuation of donepezil however experienced cognitive decline which recovered after resuming donepezil.
A 13 year old female with a traumatic left subdural hematoma was started on donepezil on day 33 after her injury, while admitted to inpatient rehabilitation, for persistent memory deficits. Repeat cognitive testing showed improvements on her MoCA score and trail making time. She did report transient episodes of diarrhea and decreased appetite but did not require medication discontinuation.
There are limited studies on the off label use of Donepezil, an acetylcholinesterase inhibitor, for cognitive rehabilitation after TBI, particularly in the pediatric population. This case series of 2 adolescent patients indicate donepezil is safe to use in the adolescent population (both in the acute and chronic stages of recovery) and supports the current limited findings that it benefits cognitive recovery following TBI.
There is a trend toward improvement in cognitive function with the use of donepezil after TBI in the adolescent population, but larger, prospective studies are needed. Adolescents tolerated donepezil without significant adverse effects.
